Surgical Excision of Benign Skin Lesions
What is surgical excision and how is it performed?
Surgical excision is a minor surgical procedure in which an altered skin lesion causing functional or aesthetic concerns is removed surgically always under local anesthesia administered to the area where the excision is performed. Excision can also be used to remove diseased or injured skin tissue for therapeutic purposes.
The surgeon uses a scalpel to remove the problematic change, i.e. a benign lesion on the skin. The skin above the lesion is incised, the lesion is then removed and the excised tissue is sent for histopathological analysis. The procedure itself is completely painless due to the use of local anesthesia. After the excision the wound is closed with sutures and covered with a sterile dressing. The wound must be kept dry and a follow-up appointment is scheduled for dressing changes. Suture removal is usually planned 8 to 12 days after the procedure. Since the procedure involves making an incision in the skin a scar will remain afterward, but the surgeon will take care to ensure that it is as minimal as possible.
Which benign lesions can be removed by surgical excision?
Some of the benign skin lesions that can be removed by surgical excision include atheromas, lipomas, fibromas, angiomas, warts, cysts, etc. These lesions vary in size and characteristics, as well as in how they appear and behave over time.
Atheroma (sebaceous gland cyst) is a benign and firm skin lesion (nodule) that forms due to the blockage of a hair follicle caused by the buildup of keratin or sebum under the skin. If the atheroma becomes inflamed it requires treatment with antibiotics and surgical intervention. If it is not inflamed it can be easily removed through a simple surgical procedure without the need for antibiotics.
A very similar formation to an atheroma is an epidermal cyst which is generally more common than an atheroma. However, atheromas most frequently appear on the scalp so it is common to find multiple atheromas on the scalp and their excision does not lead to hair loss, as the resulting scar is covered by hair. Although most common on the scalp atheromas can also appear anywhere else on the body such as the head, neck, back, etc. It is important that atheroma removal, especially on the face, is performed by a plastic surgeon to ensure the scar left after removal is as minimal as possible.
Cysts are benign, firm lesions, so-called closed pockets of tissue, about the size of a small or large pea located beneath the skin. They can be filled with fluid, a cheese-like substance, a gel-like material or other contents and usually form as a result of blocked glands or infections beneath the skin. They can also develop around foreign objects - such as earrings. Most cysts are painless, but due to their varying sizes and locations on the body they can sometimes cause discomfort. In such cases, surgical removal may be necessary.
A lipoma is a benign and the most common soft tissue tumor that develops from fat cells. It appears as a subcutaneous lump covered by normal-looking skin and does not cause any discomfort. It can be located on any part of the body. More specifically it can be found in areas where fat tissue is present, most commonly on the forearms, upper torso, underarms and the back of the neck. The main characteristic of a lipoma is its slow growth, usually stopping once it reaches a certain size, after which it very rarely continues to grow. It is most often removed for cosmetic reasons and especially in cases of multiple lipomas.
A fibroma is a benign skin growth (tumor) made up of connective and fibrous tissue. It is raised above the surface of the skin and can range in size from a few millimeters to several centimeters. It is usually skin-colored or brown and often resembles a stalk-like growth or even a mole. Fibromas can appear anywhere on the body (face, neck, groin, armpits, etc.) in both sexes and at any age, but they are most common in older individuals. Fibromas generally do not require treatment and are removed for cosmetic reasons.
An angioma (hemangioma) is a benign tumor of the skin made up of blood or lymph vessels and is often filled with blood, which is why it is also known as a "red mole." Angiomas are usually discovered incidentally during a dermatological skin examination. Although they are completely harmless and painless they often pose a cosmetic concern for individuals, which is the most common reason for their removal. They are typically a few millimeters in size, slightly raised above the skin surface and may appear on the face, scalp, torso, arms, and legs.
Warts are benign skin growths that most commonly occur as a reaction of the skin to a viral infection and can affect people of all ages. There are over 170 different types of warts and their appearance depends on the type of virus as well as the location on the body where the wart appears. They can occur individually or in clusters, have a regular or irregular shape, range in size from one millimeter to one centimeter and vary in color from light gray to dark brown. Warts can appear anywhere on the skin, but most commonly occur on the hands, elbows, palms, knees and feet. They can be removed in various ways (cryotherapy, electrocautery, etc.), but larger warts are most often surgically removed through excision especially if they cause discomfort, irritation or inconvenience.
Keratoses are benign and harmless skin growths of round or oval shape that resemble large warts. They can be skin-colored, brown, or black. They most commonly occur in middle-aged and older individuals. Keratoses do not cause any symptoms and are not painful, though they may occasionally itch slightly. They can appear anywhere on the body either as single or multiple growths, but are most commonly found in larger numbers on the face, neck, scalp, abdomen, back and chest. While they do not require treatment they can be removed in various ways for cosmetic reasons or if they itch, cause irritation or discomfort. Surgical excision is usually performed when a histopathological (PHD) analysis of the lesion is needed.
