Surgical Options

Options for Benign Lesion Removal

Cryosurgery

Cryosurgery uses liquid nitrogen (-196 ºC or –320.44ºF) to “freeze” numerous types of benign, premalignant, and select malignant growths. Cryosurgery produces selective destruction of tissue and allows for rapid repair of the wound. Collagen and cartilage are resistant to damage from cryosurgery. Cryosurgery also seems to stimulate the immune system helping to prevent the lesion from recurring.

Ellipse Excision

A scalpel is used to remove a lesion more deeply (down to the fat). The surgical site is then closed with sutures leaving a linear/line scar around three times as long as the lesion being excised. The excised tissue is sent to the pathologist for evaluation.

Punch Biopsy/Excision

A round “cookie cutter” device is used to remove a small piece of tissue. Only a few sutures are needed to close the wound. This is very useful for biopsies of skin rashes and tiny yet deep lesions. The removed specimen is sent to the pathologist for evaluation.

Shave Excision

A surgical blade is used to shave/cut off a raised lesion even/flush with the skin’s surface. The removed specimen is sent to the pathologist for evaluation. This is the quickest, easiest, least expensive, and least scarring method to remove many lesions. Many prefer this method because there are minimal physical restrictions after surgery. This is a superficial procedure without sutures.

Shave Excision with Curettage and Electrodesiccation

A surgical blade is used to scoop out/take a deeper bite to remove a lesion (i.e. wart). Then, a curette (a sharp, ring-shaped instrument) is used to scrape the area to remove any residual lesion. Electrodesiccation (heating or burning) is then performed to destroy any remaining lesion and control bleeding. The curettage (scraping) and electrodesiccation (burning) usually assures that the entire lesion is removed. Many prefer this method because there are minimal physical restrictions after surgery because there are no sutures. The removed specimen is sent to the pathologist for evaluation. This method usually leaves a flat scar.

Options for Skin Cancer Treatment

Ellipse Excision

A scalpel is used to “deeply” remove a lesion (down to the fat) as well as a surrounding border of normal skin as a safety margin. The surgical site is then closed with sutures leaving a linear/line scar three to four times as long as the lesion being excised. The excised tissue is sent to the pathologist for evaluation.

Mohs Micrographic Surgery

This technique involves the layered excision of cancer and miscroscopic examination of each layer. Thin layers are removed until the cancer is all removed. Mohs surgery is indicated for certain large, deep, or recurrent tumors, cancers with aggressive history, cancers in high-risk, difficult areas where maximum preservation of normal skin is important (i.e. eyelids, ears, or nose). This technique can be more expensive but can provide the best cure rate in cancer removal.

Shave Excision with Curettage and Electrodesiccation

A surgical blade is used to scoop out/take a deeper bite to remove a lesion (i.e. cancer that is not very deep or aggressive on the arm or leg or back). Then, a curette (a sharp, ring-shaped instrument) is used to scrape the area to remove any residual lesion. Electrodesiccation (heating or burning) is then performed to destroy any remaining lesion and control bleeding. The curettage (scraping) and electrodesiccation (burning) usually assures that the entire lesion is removed. Many prefer this method because there are minimal physical restrictions after surgery because there are no sutures. The removed specimen is sent to the pathologist for evaluation. This method usually leaves a flat scar similar to the old smallpox vaccination scars.

Topical Medications

Aldara (imiquimod) is applied to thin cancers five nights per week for six weeks. This drug stimulates one’s immune system to destroy the cancer. During treatment, the area becomes red, irritated, and inflamed. After treatment, one must be patient and let all the irritation and redness subside before evaluating the area to see if the cancer appears to be gone. This drug exerts a “field therapy” effect i.e. treating the cancer and the surrounding area (also very sun-damaged). This may decrease future cancers in the sun-damaged cancer-prone region. This treatment is indicated for patients who want to avoid scarring or those who cannot tolerate surgery because of age or poor health. Some studies suggest shave removal/biopsy of the cancer followed by Aldara works well.