Skin excision

Skin excision refers to the surgical removal of a skin lesion (mole, keratosis, cyst, nodule, suspicious lesion, etc.). It may be performed for diagnostic purposes (biopsy/excision for histological analysis), therapeutic purposes (removal of a bothersome or painful lesion) or aesthetic purposes (correction of a visible skin anomaly). Patients' motivations are varied: comfort, diagnosis, prevention or the desire for aesthetic improvement while maintaining a natural and harmonious appearance. This information is of an informative nature and does not replace a personalised medical consultation.

The different techniques

Simple excision (scalpel)

• The most common technique for small superficial lesions.
• An incision adapted to the shape and size of the lesion, closed with sutures.
• Advantages: quick procedure, generally a fine scar when performed under good conditions.
• Limitations: limited lesion size and the need for histopathological analysis depending on the indication.

Fusiform excision and layered closure

• For the removal of larger lesions or when the scar axis must be respected for a better aesthetic result.
• Closure in multiple layers (subcutaneous then cutaneous) to limit tension on the skin.

Wider excision (extended margins)

• Indicated in cases of suspicious or confirmed lesions (certain skin cancers), to ensure clear margins around the lesion.
• May require skin reconstruction (flap, skin graft) depending on the size and location.

Instrumental alternatives (electrosurgery, laser, cryotherapy)

• Certain benign lesions can be treated by laser, electrocoagulation or cryotherapy.
• These techniques may leave less tissue available for histological examination; they have specific indications and limitations with regard to diagnosis.

Pre-operative consultation

• Medical history: collection of medical history, current treatments (anticoagulants, antiplatelet agents), allergies, history of healing problems or keloids.
• Clinical examination: inspection of the lesion (size, colour, depth), examination of surrounding tissues and pre-operative photographs for traceability.
• Discussion of the technical choice: simple excision, extended margins, possibility of skin reconstruction, need for histopathological examination.
• Information on risks, the operative procedure, aftercare and alternatives.
• Provision of a quote if the procedure falls under aesthetic surgery and the mandatory 15-day reflection period for any procedure performed for aesthetic purposes.
• Informed consent and organisation of any sample collection for histological analysis.

Procedure

• Anaesthesia: most often local. Sedation or general anaesthesia may be proposed if the size, location or patient's condition requires it.
• Duration: variable (generally 10 to 60 minutes depending on the size and complexity).
• Main steps: antisepsis, localisation of the lesion, local anaesthesia, excision according to the chosen technique, haemostasis, closure by sutures or skin reconstruction, dressing.
• Hospitalisation: most often day surgery (discharge on the same day). For extensive excisions or those requiring monitoring, a short stay may be planned.
• Traceability: operative report, submission of the specimen for histopathology if indicated, prescriptions and written instructions for post-operative care.

Post-operative recovery

• Pain and discomfort: generally moderate, controlled by simple analgesics.
• Local care: dressings, cleaning as prescribed, possible application of healing cream after suturing.
• Suture removal: depending on the area, between 7 and 21 days (earlier on the face, later on the trunk and limbs).
• Activities: return to work often within a few days if the activity is not physical; sports and intense efforts are generally deferred for 2 to 4 weeks depending on the extent of the procedure.
• Monitoring: warning signs (excessive redness, increasing pain, purulent discharge, fever) require medical contact.
• Scheduled follow-up: post-operative consultation for review and delivery of histopathology results if a specimen was sent.

Results and limitations

• Evolution: the aesthetic result evolves over several months; the scar gradually fades but remains visible.
• Variability: the appearance and quality of healing depend on individual factors (skin type, age, location, skin tension, smoking).
• Durability: if the lesion was benign, excision is definitive; in the case of a tumorous lesion, dermatological or oncological follow-up may be required.
• Importance of histological analysis: it may modify subsequent management (need for further excision, enhanced surveillance).

Risks and complications

• General complications: infection, bleeding or haematoma, prolonged pain.
• Local complications: hypertrophic or keloid scar, wound dehiscence, loss of sensitivity (paraesthesia) or, more rarely, skin necrosis.
• Anaesthesia-related risk: local or general reactions (rare).
• Diagnostic risk: discovery of an unforeseen malignant lesion requiring additional treatment.
• These risks remain rare and will be detailed and contextualised during the medical consultation.

Alternatives and non-surgical options

• Monitoring: regular examination if the lesion does not have a suspicious character.
• Cryotherapy: for certain superficial benign lesions (limitations: no histological analysis).
• Laser or electrocoagulation: suitable for selected lesions; may compromise the possibility of histopathological examination.
• Aesthetic medicine (peels, injections): not indicated for the treatment of a skin lesion requiring histological diagnosis.
• The choice will depend on the nature of the lesion, the need for diagnosis and the patient's objectives.

Frequently asked questions (FAQ)

Will excision leave a visible scar? Any incision leaves a scar, but its visibility depends on the size, area, surgical technique and your healing capacity. The surgeon will explain the options for minimising the aesthetic impact.

Will I receive the histopathological report? If a specimen is sent to the laboratory, the result will be communicated to you during post-operative follow-up. It may guide any subsequent treatment.

Can I drive after the procedure? If the procedure was performed under local anaesthesia without sedation, driving is generally possible. After sedation or general anaesthesia, you will need to be accompanied and wait for the anaesthetic effects to wear off.

When can I resume sporting activities? Depending on the extent of the excision and the area treated, resumption of sport is often possible after 2 to 4 weeks; your surgeon will specify a personalised timeframe.