Video Production by Josh Melendez

This video contains an overview and procedure of an excision surgery.

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Video Transcript:

So today’s videos gonna be talking about the dermatology procedure of a simple excision.

Now, fortunately these procedures are done in the vast majority of times, while you’re awake, so it’s just local anesthesia. It’s just a little bit more than the biopsy was, so that little poke and a burn you’re gonna feel a little bit more of that, but you’re awake for the whole time.

So what’s gonna happen is we’re gonna bring you back into the room, we’re gonna find the area, draw on it, show you a picture of what we’re doing. It’ll be locally numbed and cleaned, and then we’re just, gonna simply cut around the lesion.

All right so we’ve numbed around this area, and you can see the area of the biopsy here. For this lesion we’re giving three millimeter margins. And so for three millimeter margins go all the way around, we’re doing something, like this. But you can’t close a circle, you have to elongate it and so it’s usually three to five times the width of the lesion is how, long it will be. So I’m going to be cutting into the area. Patient, all the patient needs to do is let us know, if they’re feeling any pain. And it also helps that the patient keeps breathing.

And then for each excision, we cut down to the appropriate level of depth. For this one, I don’t need a lot of depth. So I’m just going into the fat layer here, Cutting it out… And then it goes off to the lab, to see if we’ve gotten around it and that usually takes, about two weeks. We’ll prepare the wound after we’ve cut, around the lesion, and then we’ll put deep stitches and superficial stitches. Now I’m taking the sutures, and we’re going to place these underneath the skin. The deep stitches slowly dissolve over about a year, and those deep stitches look like a little string, they’re very thin, so please do not think that one week after your surgery you’re good to do whatever you need to do. That little string is holding it together for the first six weeks so the more gentle you can be with it the better.

Now sometimes those stitches spit out later instead of being absorbed by your body in about a year, sometimes they spit out. If that happens you’re gonna feel a little sandpaper-like quality to it and feel a little string there, what you can do with that is gently grab pair of tweezers and gently pull. If it’s ready to come out it’ll naturally come out if it’s not, I do not want you tugging on it. And then we’re also gonna put superficial stitches on the top, and those will be taken out usually within five to twenty-one days.

Now it’s important to not let dirty water run down over this in the shower for 24 to 48 hours after the surgery. And the reason is, is this will not be watertight. So if you let dirty water wash over something that’s not watertight, that can cause an infection. And that rule holds for most areas of the body except for lower legs. I prefer four days of no dirty water running over the area after the surgery for lower legs. We will then dress the wound and send you home with the post-operative instructions. Now please look at our post-op video that you can find the link in the description below. So that you know how to take care of your wound afterwards. Please also ask your dermatologist what the follow-up care is for this.

So we’re gonna have you back in a couple of months to see how the wound is healing. But we’re probably also going to have you back in a couple of months to look your body over again, to make sure nothing is new, changing or concerning to us. A lot of times when we do these initial biopsies or procedures, we’re taking one or two or three biopsies to see if this is just how your body grows something and it’s normal, or if what our eyes detect is something that is concerning? Actually is concerning, we’re kind of using it as a litmus test, because if we take two or three biopsies, and everything’s normal we’re gonna look at your skin a little differently then, if we took two or three biopsies and everything is abnormal. That’s gonna raise our index of suspicion for other lesions on your body.

So please have a conversation with your dermatologist about what your follow-up care is and as always, we thank you for allowing us to help you become comfortable in your skin. After watching this video please, also watch the pre-operation video, the post-operation video, and the potential complications video, so that you can achieve the best outcomes possible.

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