Excision simply means “to cut out.” Surgical excision can be used to treat melanoma, non-melanoma skin cancers, and benign lesions such as cysts, lipomas, and moles. Excision is also called “wide excision.” This is because the tumor is cut out together with some of the healthy skin around it. The healthy skin is called a margin. The reason for taking a margin is to remove any cancer cells that have spread into the surrounding tissue.
The complexity of the excision depends on the tumor type, size, and location. The simplest and most common way to excise a tumor is a technique called elliptical excision. Excision and repair are more complicated for tumors on the scalp, foot, or other challenging locations.
How is elliptical excision performed?
Elliptical excision is the most common way to excise a lesion. The area will be marked with appropriate margins around the lesion. For a low-risk non-melanoma skin cancer, the margin may be as narrow as 4 millimeters (mm). For a thick melanoma, the margin may be as wide as 2 centimeters (cm).
Your clinician will cut an elliptical (football) shape around the margin. An elliptical cut removes more skin than a circle would, but results in a better looking scar. Your clinician will close the incision with stitches, the scar will look like a thin, flat line.
After a tumor is excised, a pathologist will study the tissue that was removed. This is done to be certain that all the cancer cells are gone.
What is Mohs Surgery?
Mohs surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930’s by Dr. Frederic Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all “roots” and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.
How is Mohs Surgery performed?
Typically, Mohs surgery is performed as an outpatient procedure in the physician’s office. Although the patient is awake during the entire procedure, discomfort is usually minimal and no greater than it would be for routine skin cancer surgeries.
The area will be marked and the surgeon will remove the visible cancer, along with a thin layer of additional tissue. This procedure takes only a few minutes, and the patient waits while the tissue is being processed and examined. If residual cancer is found, the Mohs surgeon will remove additional tissue only where the cancer is present. This process is repeated as many times as necessary to locate any remaining cancerous areas within the tissue specimen.
When microscopic examination reveals that there is no remaining cancer, the surgical defect is ready for repair.