Skin lesion removal

Encyclopedia of Medicine, Apr 06, 2001 by Richard H. Camer

Laser surgery is now applied to a variety of skin lesions, ranging from spider veins to more extensive blood vessel lesions called hemangiomas. Until recently, CO2 lasers were among the more common laser devices used by physicians, primarily to destroy skin lesions. Other lasers, such as the Nd:YAG and flashlamp-pumped pulse dye laser have been developed to achieve more selective results when used to treat vascular lesions, such as hemangiomas, or pigmented lesions, such as café-au-lait spots.

No extensive preparation is required for skin lesion removal. Most procedures can be performed on an outpatient basis with a local anesthetic. The lesion and surrounding area is cleaned with an antibacterial compound before the procedure. A sterile operating room is not required.

The amount of aftercare will vary, depending on the skin lesion removal technique. For biopsy, curettage, cryosurgery, and electrosurgery procedures, the patient is told to keep the wound clean and dry. Healing will take at least several weeks, and may take longer, depending on the size of the wound and other factors. Healing times will also vary with excisions and with Mohs' micrographic surgery, particularly if a skin graft or skin flap is needed to repair the resulting wound. Laser surgery may produce changes in skin coloration that often resolve in time. Pain is usually minimal following most outpatient procedures, so pain medicines are not routinely prescribed. Some areas of the body, such as the scalp and fingers, can be more painful than others, however, and a pain medicine may be required.

All surgical procedures present risk of infection. Keeping the wound clean and dry can minimize the risk. Antibiotics are not routinely given to prevent infection in skin surgery, but some doctors believe they have a role. Other potential complications include:

• Bleeding below the skin, which may create a hematoma and sometimes requires the wound to be reopened and drained.
• Temporary or permanent nerve damage resulting from excision in an area with extensive and shallow nerve branches.
• Wounds that may reopen after they have been stitched closed, increasing the risk of infection and scarring.

Depending on the complexity of the skin lesion removal procedure, patients can frequently resume their normal routine the day of surgery. Healing frequently will take place within weeks. Some excisions will require later reconstructive procedures to improve the appearance left by the original procedure.

In addition to the complications outlined above, it is always possible that the skin lesion will reappear, requiring further surgery.

• Books
• Fewkes, Jessica L. Illustrated Atlas of Cutaneous Surgery. New York: Gower Medical Publishing, 1992.
• Roenigk, Randall K., and Henry H. Roenigk. Roenigk & Roenigk's Dermatologic Surgery: Principles and Practice. New York: Marcel Dekker, 1996. Periodicals
• Alster, Tina S., and Amy B. Lewis. "Dermatologic Laser Surgery: A Review." Dermatologic Surgery 22 (September 1996): 797-805.
• Lener, Elizabeth V., et al. "Topical Anesthetic Agents in Dermatologic Surgery: A Review." Dermatologic Surgery 23 (August 1997): 673-683. Organizations
• American Academy of Dermatology. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. http://www.aad.org.
• American Society for Dermatologic Surgery. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
• American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.