Wide-local Excision for Skin Cancer

In wide-local excision, the skin cancer and a small margin of healthy tissue around it is cut out, usually in a football-shaped ellipse. Once the tissue has been removed, the edges of the wound are sutured together. The tissue then is sent for processing and margin evaluation by a pathologist.

Wide-local excision often is used for BCC and SCC on lower risk body sites (such as the body or arms/legs) and for early stage melanomas that still are confined to the skin and have not spread into deep levels of tissue or other parts of the body. If caught early, the procedure can cure melanoma. In other cases, additional treatments may be required.

Since wide-local excision requires the removal of healthy skin, it results in a larger wound. In certain places on the body, such as the head and scalp, it can be difficult to suture the wound edges back together, necessitating skin grafts to close the wound. Recovery time can vary greatly depending on the size and site of the cancer.

Why choose wide-local excision for skin cancer

While it is used primarily on melanomas, it also can be used to treat basal and squamous cell carcinomas. For small, well-placed tumors, it offers results that are both medically and cosmetically effective. It offers a high cure rate and allows for microscopic examination of surrounding tissue. Unlike chemotherapy and radiation, it can be accomplished in one session.

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What you should know about wide-local excision for skin cancer

  • The biopsy site is cleansed, and sterile towels are placed around it.
  • Local anesthetic is used to numb the skin.
  • Removed tissue is sent to a laboratory for analysis.
  • The wound is closed with sutures or stitches if necessary.

Possible risks

While wide-local excision is a safe and effective procedure, all medical procedures carry some risk, though they are minimized in the hands of a qualified ASDS dermatologist. Risks include:

  • Infection
  • Scarring
  • Bleeding
  • Allergic reaction to anesthetic
  • Healing problems

How to prepare for the procedure

Before the procedure, an ASDS dermatologic surgeon will review the patient's medical history and conduct a physical exam. This is the time for the doctor and patient to discuss expectations, potential risks/benefits and outcomes of the procedure. Patients should tell their doctor:

  • About any prescribed and over-the-counter medicines they are taking as well as any supplements.
  • If they have a history of bleeding or other medical problems.
  • About any allergies, especially allergies to anesthetics.
  • If they are pregnant.

What to expect after the procedure

  • The bandage placed over the treatment area should be kept clean and dry.
  • The surgeon will advise how to clean, apply an antibacterial ointment and change the bandage on the treatment area.
  • Stitches or sutures usually will be removed one to three weeks following the surgery.
  • Pain usually can be treated with an over-the-counter pain reliever.