Definition & Overview
Skin lesions are lumps, sores, or areas of the skin that are raised or have an abnormal appearance. Some are benign, but some can also be a sign of skin cancer. These can be removed for cosmetic purposes or as a part of a treatment plan through shaving (shave excision technique), a simple routine procedure performed under local anaesthesia.
Who Should Undergo and Expected Results
The shaving excision technique can be performed in patients with epidermal lesion (an abnormal growth on the upper layers of the skin) and dermal or subcutaneous lesions (affect the inner layers of the skin). Examples are:
- Crusts or scabs
- Skin ulcers
Lesions may occur as a single abnormal growth or in clusters. They are also categorised based on their appearance, such as:
- Linear lesions, or straight lesions
- Annular lesions, or rings with central clearing
- Target lesions, or rings with central features
- Reticulated lesions, or lacy and networked lesions
- Herpetiform, or groups of papules and vesicles similar to a herpes simplex infection
- Zosteriform, or clusters of lesions similar to a herpes zoster infection
- Nummular lesions, or circular ones
The shaving procedure can effectively remove skin lesions that are relatively small and uncomplicated. It is a simpler and less expensive alternative to a full-thickness skin excision, which is a more invasive method reserved for larger and more complex lesions. The procedure produces minimal scarring and does not require stitches.
Although effective, the procedure does not guarantee against future lesion growth.
How is the Procedure Performed?
Shave excision of epidermal or dermal lesions is performed under local anaesthesia, which works in two ways for this procedure; aside from making the lesion site numb, it also causes the lesion to rise upwards, making it easier for the doctor to remove it through a simple shaving technique. The doctor can then proceed to cut off the lesion by making several horizontal cuts using a sharp razor. Due to the anaesthetic used, patients typically only feel a pulling sensation.
The shaving procedure is followed by electrosurgical feathering, which is performed to improve the appearance of the skin after the lesion is removed, to prevent scarring, to smoothen the edges of the wound and most importantly, to make sure no traces of the growth remain on the surface of the skin. This is done with the use of a dermal loop electrode.
The doctor will then apply aluminium chloride hexahydrate on the wound to control bleeding, if any, as well as an antibiotic ointment to soothe the area, promote faster healing, and prevent infections. The wound is then covered with a sterile bandage for protection.
The wound should be kept dry for 24 hours, and the patient will be instructed to apply a topical antibiotic on the wound at least twice a day as the wound heals.
Possible Risks and Complications
Patients who undergo shaving of epidermal or dermal lesions can expect to feel some discomfort, similar to a burning sensation, at the site where the lesion was removed. If the pain is bothersome, they can take over-the-counter pain relievers, such as ibuprofen or acetaminophen, when and as needed.
There is also a risk of scarring, which patients can try to reduce by applying a topical silicone gel or a vitamin A cream on the wound. The scar may appear bright red during the first few weeks, but tends to lighten in appearance as time goes by.
Another risk is skin discolouration, which can occur if the wound becomes permanently darker due to sunburn. This is why it is important to use a bandage and to avoid too much exposure to sunlight as the wound is healing.
Also, although infection is rare, it is possible. Signs of an infection include extreme tenderness, swelling, increasing redness, and a pus discharge.
Lastly, there is a risk that the lesions will grow back following the procedure.
MacNeal RJ. “Description of skin lesions.” Merck Manual. http://www.merckmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/description-of-skin-lesions
Goldberg LH, Segal RJ. “Surgical pearl: a flexible scalpel for shave excision of skin lesions.” Journal of the American Academy of Dermatology. 1996. 35(3):452-453. http://www.jaad.org/article/S0190-9622(96)90612-X/abstract