Video Production by Josh Melendez

Learn about the delayed closure excision dermatology procedure. This procedure is sometimes referred to as “slow mohs.” Watch the Mohs Procedure to learn about their similarities and differences.

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Video Transcript:

So today we’re going to be talking about the procedure of a delayed closure excision. Now we usually use this procedure when we need to cut something out that’s in an area of high cosmetic importance, or in an area where we don’t have a lot of extra skin to get a wide margin and close you up. And your local dermatologist will explain why they chose this procedure and what it entails.

This video is going to give you some basic generalities of what you can expect. So this is a biopsy site from a melanoma in situ. And this is on the anterior shin and so anterior shins do not have a lot of room to be able to close. They’re pretty tight areas. What I’ll do to start is just clean it with some alcohol. We’re gonna draw around the area, that we think will get around the lesion, and then we will numb it, and we will cut it out. Ok, so the area has been numbed and what I’m going to be doing is cutting this area out and then removing it. So what I’m going to do is test the area to see if it’s numb, and then we just cut it out.

Now we do these delayed closure excisions on areas where we don’t have a lot of room to pull tissue together. So this is a wound on a shin, which means there’s not a lot of room to pull this together. So we’re trying to take wide margins, while at the same time, keeping the wound is reasonably closed as possible. So now we do is we take this piece of tissue, and we put it in a bottle and it goes off to the lab. One other thing that I’m going to do with this lesion is because it’s going to be on such a tight area, I’m going to put some stitches here and here, and pull this together and that will help the skin to stretch over the next 24 hours.

So hopefully we have a little easier time of closing it. Now if we do not have clear margins and when the patient returns to the clinic tomorrow, we’ll take a little bit more and then re-bandage it and they go home, come back the next day. And we keep this process going, until we have clear margins. And whenever we have clear margins and they’ll come back in, and we will close the area. We’re going to clean the area off and we’re going to put a pressure dressing on, and then you’ll go home for approximately 24 to 48 hours while that specimen is being processed.

Now while you’re home, usually you do not experience that much pain, but if you do, please take Tylenol for the pain if you’re allowed to take Tylenol. Another tip is to elevate the area above the level of your heart to help get the swelling down. Because oftentimes when things swell, it hurts and so if we can get the swelling down, and take some Tylenol that usually helps. The last tip is you can ice the area for five minutes an hour while you’re awake, and that will also help decrease the swelling.

Now some people say, “Well there’s going to be an open hole in my body, isn’t that going to bleed?” And the answer to that question is, yes that might happen, especially if you’re taking blood thinners. If you start to experience oozing or bleeding, just hold pressure for five minutes by the clock. No peeking is allowed. Every time you peek, the clock restarts. But if you hold five minutes of firm pressure, which usually means about five pounds of pressure to the area, and usually the oozing will stop. Now it might start again in you know, an hour or two, but all you have to do then is apply five minutes of firm pressure.

Now you usually come back into the clinic 24 to 48 hours after the first piece was taken out. And please bring a book or something to read because we are dependent upon the lab giving us the result, and sometimes the lab needs to do special stains or extra studies in order to get us what we need. And what we need is to know if we either have clear margins under the microscope, or if we need to take more tissue. If we have clear margins under the microscope and two thumbs up, what we do is figure out how to close the wound, and then send you home, usually with stitches. No stitches can usually be removed within 5 to 21 days.

So, please ask any and all questions you have before your procedure, so that your local dermatologist can keep you informed. Because remember, an educated patient is always the best patient.

Patient: When I was growing up, we didn’t even have sunscreen, it hadn’t been invented yet. So we were always out in the sand. We were playing golf. We were swimming pools. We were delivering those papers, that we, we were outside all the time. Obviously if we had known, if I had known what I know now, then I would have been covering up a lot better, then I’ve hopefully wouldn’t have been having all of these procedures.

The one that, was that gave me the most trepidation was the one on my nose. Because I was concerned about possibly being somewhat disfigured by the, by the procedure. But he did a skin graft on my nose, and everything is symmetrical. I’m very, very happy with the work that was done. If I were talking with someone who was going to go through what I have been through, it, it needs to be done. You’ve been diagnosed, you have an issue and you need to have it taken care of. There’s a little pain involved, you’re gonna experience some needles, you’re going to experience that wound care, taking care of your stitches, keeping an eye on things. Most importantly is, is pre-emptive try to look at your face, to look at your body. See if you can find anything before you go in but, you need to have it done. There’s a little pain involved, but in the long run, you’re gonna be much better off the earlier you have it taken care of.

About the author

Dr. Anderson with Doctors Quarterly Magazine - Cropped
Dr. Reagan Anderson

Dr. Anderson is a Board Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and is actively involved in patient and healthcare provider education on dermatology conditions and treatment.

Colorado Dermatology Institute
8580 Scarborough Drive / 1220 Lake Plaza Drive
Colorado Springs, Colorado