Skin lesion removal
Skin lesion removal encompasses various medical procedures aimed at excising or destroying abnormal growths on the skin, including actinic keratoses and different types of skin cancers. Actinic keratoses are precursors to cancer and are typically warty lesions that may prompt removal as a precaution. Among skin cancers, basal cell carcinoma is the least aggressive, appearing as a small, pearly lesion that generally does not metastasize. In contrast, squamous cell carcinoma presents a greater risk, as it can spread if untreated and is characterized by firm, scaly tumors. The most serious type, malignant melanoma, can appear as an irregular mole and is known for its rapid invasion and potential to metastasize.
The removal procedure varies based on the lesion's type, size, and location, often performed in a dermatologist's office under local anesthesia. Techniques include scraping with a curette or excision with a scalpel for larger lesions, while radiation may be used for delicate areas like the eyelids. Recovery may involve cosmetic surgery to restore appearance, particularly for extensive removals. Cure rates differ by cancer type, with basal cell carcinomas having about a 95% cure rate when treated appropriately, underscoring the importance of early detection and treatment in improving outcomes.
Skin lesion removal
Anatomy or system affected: Arms, hands, nose, skin
Definition: The removal of cancerous and precancerous skin lesions under local anesthesia with a curette or scalpel, an electric needle, or liquid nitrogen
Indications and Procedures
Actinic (or solar) keratoses and skin cancers affect millions of Americans each year. Actinic keratoses, warty lesions that are considered to be premalignant, are often removed as a precaution. Among skin cancers, basal cell carcinoma is the least harmful. The lesion may appear on the skin surface as a small, flesh-colored, or pale pink spot, usually with a raised edge that has a translucent, pearly appearance. It grows slowly and will rarely spread (metastasize) to other parts of the body. Squamous cell carcinoma is more dangerous. It appears on the surface as a small, firm, scaly tumor with an indistinct margin. Untreated squamous cell malignancies may metastasize. Malignant melanoma, called black cancer, is the most dangerous of the three types. Melanoma lesions may resemble a mole with an irregular shape and can be red, blue, black, brown, gray, or even white. Melanoma rapidly invades nearby tissue and can metastasize readily to other parts of the body.
The method of treatment will depend on the type of lesion and its location and size. Most are treated in the dermatologist’s office under local anesthesia. More widespread lesions may be removed in the hospital under general anesthesia.
The site is cleaned with a germicidal swab, and a local anesthetic is injected under the skin. The lesion is scraped away with a curette, an instrument with a small, scoop-shaped cutting head. An electric cautery kills any remaining lesion cells and seals off small blood vessels.
The curette is used on basal cell carcinomas that are less than one or two centimeters in diameter. Larger lesions are removed with a scalpel, and stitches close the incision. Cancers on the eyelids, on the tip of the nose, or near facial nerves may be removed with radiation (using X-rays or another source). If the area treated is large, cosmetic or reconstructive surgery is performed to restore the patient’s physical appearance.
Uses and Complications
There is about a 95 percent cure rate for treated basal cell carcinomas. The cure rate for squamous cell carcinomas is only slightly less, especially if the lesion has been treated at an early stage. The cure rate for malignant melanomas is low unless they are diagnosed and treated early.
Bibliography
Hall, John C., and Gordon S. Sauer. Sauer’s Manual of Skin Diseases. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.
Health Library. "Skin Lesion Removal." Health Library, November 26, 2012.
Karen, Julie K., and Jamie Kleiman. “Basal Cell Carcinoma Treatment.” The Skin Cancer Foundation, Apr. 2021, www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/bcc-treatment-options. Accessed 21 July 2023.
McKee, Phillip. A Concise Atlas of Dermatopathology. New York: Gower Medical, 1993.
Mehregan, Amir H., et al. Pinkus’ Guide to Dermatohistopathology. 6th ed. Norwalk, Conn.: Appleton & Lange, 1995.
Turkington, Carol, and Jeffrey S. Dover. The Encyclopedia of Skin and Skin Disorders. 3d ed. New York: Facts On File, 2007.
Weedon, David. Skin Pathology. 3d ed. [s. l.]: Churchill Livingstone/Elsevier, 2011.