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SUMMARY
Surgical excision is a mainstay in a dermatologic surgeon’s armamentarium and is the most common and well-accepted procedure for both melanoma and nonmelanoma skin cancer.
The incision should uniformly release the skin edge to the target anatomic depth while minimizing beveling of the wound edge.
In simple excision, the ellipse should form a 30- to 75-degree angle at the apex, and its length should be three or four times its width to allow for a clean linear closure.
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DON’T FORGET
During the excision, the scalpel blade should be held sharply perpendicular to the skin surface and be kept in that position throughout the entire pass of the incision.
Applying gentle traction to stabilize the surrounding skin is key for achieving a smooth incision curve and avoiding chatter.
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CLINICAL PEARLS
Any undue resistance should alert the surgeon to reevaluate the accuracy of the anatomic location of the surgical plane.
For primary closures, an undermining width of 0.5 to 1.0 cm would suffice in most cases.
Scissors have the advantage of providing greater tactile feedback, which can help the surgeon detect the release of tissue as well as resistance.
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PATIENT EDUCATION POINTS
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Surgical excision, also known as shave excision, is a mainstay in a dermatologic surgeon’s armamentarium and is the most common and well-accepted procedure for both melanoma and nonmelanoma skin cancer. The procedure involves removing diseased or damaged tissue using a scalpel along with a small amount of clinically healthy tissue to ensure complete removal. The main objective of a standard surgical excision is to completely remove a lesion to prevent progression and reoccurrence of disease while minimizing impairment in function and cosmesis. This usually requires predetermination of a margin around the tumor as well as postoperative histologic evaluation of the excised tissue with “bread loaf” permanent sectioning.1 This chapter will detail the clinical indications of surgical excision, the surgical techniques involved, and the appropriate perioperative care.
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Basal cell carcinoma (BCC) is the most common form of cancer in humans and is highly curative via office-based procedures if diagnosed early. Treatment of BCC is largely guided by its risk classification, and the National Comprehensive Cancer Network (NCCN) stratifies BBC risk level by a multitude of parameters. Features that suggest low risk include primary occurrence, a size smaller than 2 cm in lesions occurring in the trunk and extremities and smaller than 1 cm for lesions in the head and neck, well-defined borders, and a nodular or superficial growth pattern.2,3 A lack of immunosuppression, a lack of history of radiation exposure to the ...