You noticed a growth on your skin that didn’t seem quite right so you made an appointment at Bryn Mawr Dermatology to have it checked out. The dermatology experts agreed that further investigation was recommended due to its physical appearance, any symptoms you might be experiencing, and the lesion’s history. During your visit your provider took a small sample of the lesion in the form of a biopsy that was sequentially sent to a dermatopathologist to review under a microscope, and they identified the cells as a skin cancer or other skin lesion that requires attention. What comes next?
Your diagnosing physician will decide what the appropriate method for treatment is for your specific situation. The diagnosis, location and size are all factors in their recommendation. Usually an in-office procedure in either the form of a small excision or Electrodessication & Curettage (ED&C) will suffice to remove the entirety of the lesion. In rare cases, we may refer you to a specialist to complete the skin cancer removal and/or further diagnostic testing to complete your care.
There are two main scenarios when surgical dermatology is necessary to remove a lesion. Either the lesion has been diagnosed as a growth that requires elimination or your provider has visually diagnosed you with a benign subcutaneous growth that requires removal due to symptoms you are experiencing. This happens most frequently with cysts and lipomas.
For excision treatments in Villanova or Collegeville, contact our dermatologists today at 610.525.7800! or easily book an appointment by clicking the Schedule Now button at the top of the page. We look forward to caring for you!
Any time a doctor tells you that you need surgery it can feel daunting, even if it is an in-office procedure that by most standards is considered “minor.” Know that at Bryn Mawr Dermatology we respect that every surgery we perform is as unique as the patient having it, and we are more than willing to walk you through what to expect before, during and after the procedure. We encourage you to ask questions and be involved in your medical care, especially since someone who is diagnosed with skin cancer has increased odds of being diagnosed with additional skin cancers within the next 10 years. Be assured that even if you have questions after hours, there is always a doctor on call for post-procedural questions.
Generally, there is nothing we ask a patient to do to prepare for their procedure. In the majority of cases patients who drive can take themselves to and from the visit, the only exception is when the lesion of concern is so close to the eye that the bandage we apply after the procedure could impede vision. We will tell you if that is the case. All current medications should be continued as prescribed, but do let us know what they are if they are not already in your chart. We will proactively ask you any questions we need to know about your situation so we are amply prepared to provide you with the best possible care. Wear comfortable clothing that makes the surgical site easy to get to and anticipate taking it easy for a couple weeks after the procedure so your body can focus on healing.
When your provider finalizes the diagnosis of the lesion she is planning to remove, she will decide to either excise the lesion or remove it via ED&C.
Electrodessication & Curettage (ED&C) is a long complicated term for a procedure that is brilliantly simple. Once we review your medical history including current medications and allergies we will confirm your diagnosis and the site we are treating. Next the medical team will verbally review the procedure details and post-procedural instructions with you. You will also receive a hand-out with this information in written format and some wound care products. Once you are comfortable with what to expect they will apply isopropyl alcohol to your skin to clean it. They will then use injectable Lidocaine with Epinephrine to topically numb the skin and underlying tissues and restrict blood flow to the area. Your provider will then use a specialised tool called a curette to scrape off the topmost layer of skin. She will use an eclectic cautery device to stop any bleeding and further destroy the tissue that has been diagnosed as abnormal. This series of events will happen 2 more times to ensure that all of the questionable cells are removed and then the wound will be bandaged. ED&Cs are proven to be 93% successful in treating superficial skin cancers, take less than 15 minutes and do not require stitches. The procedure will result in a roundish scar that is two to three times as large as the original visible lesion.
Excisions are appropriate procedures to treat skin cancers and other abnormal cellular growths that have developed deeper than the topmost layer of skin. They require a similar preparation as an ED&C: medical chart review, discussion of what to expect and aftercare instructions, and then cleansing and numbing the skin. At that point the provider will carefully use a scalpel and other sterilized tools to remove the lesion and prepare it for delivery to the laboratory. She may remove a margin of healthy tissue around the lesion as dictated by the lesion type and by scientifically proven success rates. The wound will be repaired using two layers of suture material. The deeper layer of sutures serve to secure the underlying tissues to each other and provide stability. They will slowly dissolve over time. The superficial layer of sutures abutt the skin and facilitate the healing process. The wound will be bandaged with a bulky dressing called a pressure dressing. You can anticipate being in our office for 30-60 minutes and coming back to see us in 7-14 days for suture removal of the top layer of stitches. After the sutures are removed, the surgical site will be healed enough to return to normal activities and result in a linear scar that fades, but does not disappear, over time. The dermatopathologist will examine your specimen to ensure the borders of the tissue removed are clear of abnormal cells. Excisions have a cure rate of 95%.
Yes. There are options that Bryn Mawr Dermatology’s specialists can recommend to you if they are appropriate for your situation. There are topical chemotherapy drugs that may be the best options in certain scenarios and radiation can also be an option. Additionally we offer Mohs Micrographic Surgery – a layered technique that takes more time than a traditional excision, but results in a smaller, less noticeable scar. There are even procedures we can recommend to help prevent additional skin cancers from forming once a patient is identified as high risk, or has a history of many skin cancers. When a dermatology specialist chooses which treatment option is best for a patient there are a lot of factors to consider:
Exact diagnosis – this can affect the lesion’s potential to respond to alternative therapies
Lesion size and location – lesions that are extremely large or small, or on top of either aesthetically important or functionally important areas may be best suited for non-surgical removal or a procedure called Mohs Surgery; depending on the exact location we may refer you to another specialist who is more equipped to handle your diagnosis (ex. a hand surgeon)
The patient’s age and health – certain patients may not be able to comfortably tolerate a surgical procedure for these reasons and we may look into alternatives
The quantity of diagnosed lesions – due to genetics, UV exposure and other factors, some patients experience dozens of skin cancers or pre-cancers at once and we may suggest field treatment for these patients that allows us to treat more than one lesion at a time
Immediately after the procedure the medical team will apply a pressure dressing to the wound. This will serve to keep the site clean, protected and under mild pressure to help reduce bleeding and swelling. The dressing may look a little bulky, but we recommend that you leave it in place for at least 24 hours to reduce the probability of break-through bleeding and infection. After 24 hours, we suggest that you remove the pressure dressing, apply a thick layer of Aquaphor or Vaseline, and cover it with a non-stick dressing and tape. Change your dressing every 24 hours until it is time to get your stitches removed. Doing this will aid in the healing process and suture removal. The theory of wound healing has changed over time, and it is no longer suggested to “air out” a wound or let it scab over. Keeping it “goopy and covered” is the best way to ensure your surgical site heals up quickly and with the smallest amount of scarring.
With any procedure that breaches the skin barrier there is a chance that there will be bruising and/or swelling. This can last up to four weeks, so book your social appearances & family photos accordingly! During the healing process it is best to take it easy and not apply too much stress on the healing wound. You can certainly go about your normal daily activities, but you may want to modify your exercise routine to accommodate the healing wound. Your sutures will need to stay in place from 7-14 days depending on the site and size of the surgery. In rare cases patients may pop a stitch or develop an infection, even if the wound care instructions are followed exactly. We recommend that you stay in the area during the time when you have stitches in so that we can be available to you in the case that your healing process does not go as expected. You will NOT be able to swim or soak your healing wound in water during the healing process – this means NO POOLS, RIVERS, OCEANS, LAKES, HOT TUBS OR BATHS. You may continue bathing and showering as usual, but always change a dressing that gets wet.
After the stitches are out, we suggest that you are extra careful about sun protection. The surgical site will continue to remodel for many months and healing skin has the potential to permanently discolor when exposed to UV rays. If we have removed a skin cancer, we will likely ask to see you back in the office to check the surgical site in about three months. This allows us to assess how you are healing and ensure that there is no recurrence at the site. It also gives us an opportunity to review other portions of your skin to see if we can identify any new suspicious lesions. Remember, that once you have been diagnosed with a skin cancer your chances of being diagnosed with another is significantly higher than someone who has not.
If you are concerned that you have a growth that requires treatment, call us at 610.525.7800 to make an appointment with one of our specialists.
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