An excision is a minor surgical procedure in which the GP attempts to remove a skin lesion completely. The lesion is cut out using a surgical blade. The wound is then usually closed with stitches.
The procedure is performed under local anaesthetic. The removed tissue may be sent to a pathology laboratory for examination under a microscope.
When can an excision be performed?
An excision may be considered if:
- a skin lesion needs to be removed completely;
- microscopic examination of the entire lesion is required;
- a benign skin lesion is causing symptoms;
- the lesion is unsuitable for a superficial shave excision;
- the GP wants to have a small suspicious skin lesion examined in full.
Not every skin lesion can be removed safely at the GP practice. A large, deep or unfavourably located lesion may require referral. Referral to a dermatologist or surgeon may also be necessary if there is a strong suspicion of melanoma or another high-risk skin tumour.
If immediate complete removal is not required or possible, the GP may first perform a skin biopsy.
Initial assessment by the GP
Before an excision can be scheduled, the GP must assess the skin lesion during a regular consultation. The GP will consider:
- the type of skin lesion;
- its size, depth and growth pattern;
- its location on the body;
- any changes or symptoms;
- the reason for removing it;
- whether laboratory examination is required.
Together, you will discuss whether removal at the GP practice is possible and medically appropriate. If an excision is suitable, a separate appointment will be scheduled. The procedure will not usually be performed during the initial assessment.
Preparing for the procedure
Please tell the GP beforehand:
- whether you are allergic to local anaesthetics, disinfectants or adhesive dressings;
- whether you have previously experienced problems with local anaesthetics, surgery or wound healing;
- whether you have diabetes, vascular disease or a weakened immune system;
- whether you take blood-thinning medication.
Blood-thinning medication usually does not need to be stopped for a minor skin procedure. Never stop taking this medication without medical advice. The GP will assess whether any additional precautions are necessary in your situation.
You may eat and drink as usual unless you have been advised otherwise. Wear loose-fitting clothing so that the treatment area can be reached easily and your clothing does not rub against the wound afterwards.
What happens during an excision?
You will lie or sit on the examination couch. The GP will check the skin lesion and may mark the area that needs to be removed.
The following steps are then taken:
- the skin is cleaned and disinfected;
- you receive one or more local anaesthetic injections;
- the GP checks that the area is sufficiently numb;
- the skin lesion is usually removed through a small oval-shaped incision;
- any bleeding is stopped;
- the edges of the wound are closed with stitches;
- the wound is covered with a plaster or dressing.
During an excision, the skin lesion is removed more deeply than during a shave excision. Depending on the type of lesion, the excision may extend into the tissue beneath the skin.
The local anaesthetic injection may briefly cause a stinging or burning sensation. Once the anaesthetic is working, you should not feel pain during the procedure. You may still feel touch, pressure or movement.
You can go home immediately after the procedure.
Examination of the removed tissue
The removed tissue may be sent to a pathology laboratory for examination under a microscope. This can determine what type of skin lesion it is.
Where relevant, the pathologist can also assess whether the surgical margins are clear and whether the lesion is likely to have been removed completely.
The GP will discuss whether laboratory examination is necessary and how you will receive the results. Results are usually available within two to three weeks. We will contact you if further examination, an additional excision or referral is required.
After the procedure
The local anaesthetic usually continues to work for several hours. Once it wears off, the wound may feel tender or painful. If necessary, take paracetamol according to the instructions on the packaging.
Always follow the individual wound-care instructions provided by the GP. The following advice will usually apply:
- keep the wound and dressing dry for the first 48 hours;
- replace the dressing if it becomes wet, dirty or soaked with blood;
- touch the wound as little as possible;
- avoid pulling, bumping or rubbing the area;
- avoid exercise, heavy lifting and movements that place tension on the wound;
- do not swim or take a bath until the wound has closed properly;
- protect the scar from sunlight once the wound has completely healed.
Depending on the location of the wound, the stitches are usually removed after approximately 5 to 14 days. You will receive an appointment or further instructions for this.
Scarring and possible complications
Every excision leaves a permanent scar. At first, the scar is often red or pink and may feel slightly raised. It will usually become flatter and less noticeable over the following months.
The size and final appearance of the scar depend on factors including:
- the size and location of the skin lesion;
- tension on the wound;
- your skin type;
- how your skin heals.
Possible complications include:
- bleeding after the procedure;
- bruising or swelling;
- a wound infection;
- the wound reopening;
- delayed wound healing;
- altered sensation around the scar;
- a noticeable, widened or raised scar;
- recurrence of the skin lesion if it could not be removed completely.
When should you contact the practice?
A small amount of blood or wound fluid beneath the plaster is usually not a cause for concern. If the wound starts bleeding, press firmly on it with clean gauze or a clean cloth for 15 minutes without releasing the pressure to check the wound.
Contact the practice on the same day if:
- the wound continues to bleed despite applying firm pressure;
- the pain is clearly increasing;
- the skin around the wound becomes increasingly red, warm or swollen;
- pus comes from the wound;
- the wound reopens;
- you develop a fever or feel unwell;
- you are concerned about the wound for any other reason.
Outside our opening hours, contact the out-of-hours GP service if your symptoms cannot wait until the practice reopens.
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