II. Definition

  1. Full dermal thickness excision

III. Indications

  1. Diagnostic (e.g. Suspected malignancy)
    1. All pigmented lesions must be full thickness excision
    2. Melanoma therapy is based on lesion depth
  2. Complete excision of lesion for cure
  3. Cosmetic indications

IV. Preparation: Excision path

  1. General
    1. 3:1 Elliptical Excision prevents dog ears at corner
  2. Mark planned excision before anesthesia injected
  3. Long axis should be parallel to Skin Tension Lines
  4. First mark intended width of excision
    1. Use minimal margin (1-2 mm)
    2. Perform wider excision later if biopsy positive
      1. Nodular Basal Cell Carcinoma: 3-4 mm margin
      2. Squamous Cell Carcinoma: 5 mm margin
      3. Malignant Melanoma: Margin varies per lesion depth
  5. Next mark intended length of excision
    1. Excision length should be 3 times the width
  6. Draw excision path (elliptical or fusiform)
    1. Connecting width and length points
    2. Corner angles should be 30 degrees

V. Procedure

  1. Clean site with Betadine or Hibiclens
  2. Anesthesize site with Local Lidocaine
  3. Drape excision site
  4. Excise lesion along drawn path with #15 blade
    1. Make each scalpel pass smooth and continuous
    2. Depth of excision should be to subcutaneous fat
    3. Blade should be vertical to skin
      1. "Build a pyramid - Do not dig a ditch"
      2. Do not angle blade inward toward lesion
        1. Slightly outward beveling preferred over inward
  5. Free corners of ellipse and work toward center
    1. Gently lift corner with skin hook or adson with teeth
    2. Release corner by cutting between Dermis and SQ fat
    3. Excise full dermal thickness to ellipse center
    4. Repeat to free other corner and excise to center
    5. Immediately place lesion in formalin when excised
  6. Obtain adequate hemostasis
  7. Undermine skin edges if larger excision (if Melanoma not suspected)
    1. Hold skin edge with skin hook
    2. Use horizontal blade or iris scissors
    3. Separate Dermis from subcutaneous fat
    4. Tissue relaxation of 1 cm requires 3 cm undermining
  8. Suture skin closed
    1. See Suture Selection
    2. Deep-buried interrupted vicryl Sutures if needed
      1. Prevents seroma formation below lesion
    3. Simple interrupted Nylon Suture
  9. Remove residual blood from wound
    1. Gently squeeze lesion
    2. Apply direct pressure for 10 minutes
  10. Bandage wound site
    1. Apply antibiotic ointment
    2. Sterile bandage

VI. Follow-up

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Ontology: Excision biopsy (C0184921)

Definition (SCTSPA) Biopsia que extrae una lesión completa, con tejido circundante o sin él
Definition (SNOMEDCT_US) Biopsy that removes an entire lesion, with or without surrounding tissue
Definition (NCI) A surgical procedure in which an entire lesion is removed for microscopic examination.
Definition (NCI_NCI-GLOSS) A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
Concepts Diagnostic Procedure (T060)
SnomedCT 8889005, 277261002
Dutch excisiebiopsie
French Biopsie par excision
German Exzisionsbiopsie
Italian Biopsia per escissione
Portuguese Biopsia por excisão
Japanese 切除生検, セツジョセイケン
Spanish Biopsia por escisión, biopsia quirúrgica (calificador), biopsia por resección (calificador), biopsia por resección (procedimiento), biopsia por escisión, biopsia por escisión (procedimiento), biopsia por resección, biopsia quirúrgica
Czech Excizní biopsie
English excision biopsy, biopsy excisional, biopsy excision, biopsies excisional, excisional biopsy, surgical biopsy, Excisional biopsy, Excision biopsy (qualifier value), Excisional biopsy (procedure), Excision biopsy, Excisional Biopsy
Hungarian Excisio biopszia