Excisions for Skin Lesions

Centrally located in Oahu, we offer a comprehensive skin lesion center that hosts a full surgical unit where a variety of surgical approaches are used, including excisions. We regularly excise different types of lesions, including skin cancers, atypical moles, cysts and many others. We would be happy to discuss the details of your diagnosis with you and answer any questions that you may have prior to and throughout your procedure.

  • Surgery is done in a surgical room at the clinic. The surgeon will meet with you before performing your procedure to discuss your diagnosis, management options, and the benefits and risks of surgery.

  • The surgeon also will draw the surgical plan to show and explain it to you. The best surgical plan is determined individually, based on the diagnosis and location of the lesion, as well as to optimize function and cosmetic appearance.

  • The area around your skin cancer will be numbed using local anesthetic. After making sure the area is numb, the excision and repair will be performed. The excised skin will be evaluated by our dermatopathologist and we will call you to share the results of the microscopic evaluation with you.​​

During Your Surgery

Pre-Surgical Instructions for Excisions

  • Please eat breakfast and eat regular meals before surgery.

  • Bathe before your surgery as you may be asked to avoid getting the area of your surgery wet until 48 hours after surgery.

  • Do not wash with products that contain alcohol before your surgery.

  • Wash your hair only with shampoo and conditioner. Do not use hair spray or hair gels. These may contribute to a surgical fire.

  • Do not drink alcohol for 24 hours before surgery.

  • Dress comfortably. You may want to bring a sweater or jacket as the waiting room can be chilly.

  • Do not wear makeup in the area of the surgical site.​

  • Provide a list of your medications to your surgeon. If you have been prescribed antibiotics prior to surgery, please take them as instructed. Take all your regular medications the day of surgery unless otherwise directed by your physician.

  • Do not stop blood thinning medications unless directed by your surgeon. This includes Warfarin, Coumadin, aspirin, Plavix and Pradaxa. Notify medical team if you are taking any of these medications.

  • You will need a driver if your surgical site is close to your eyes. Your visual field may be obstructed by a dressing, which can make driving unsafe. Otherwise you can drive yourself to your appointment if you prefer

  • If you have a driver, they may want to bring a book, magazine, a computer or other items to help pass the time during the procedure. Typically, you should not have to wait long before your procedure.

  • Notify us if you:

    • Have had a joint replacement in the past two years.​

    • Have artificial heart valve(s)

    • Are taking Warfarin (Coumadin) as this requires a blood test (INR) within one week of surgery.

If you have questions, contact Complete Dermatology between 8 a.m. and 5 p.m. M-F, or you can reach Dr. Flament directly with the number provided on your post-surgical handout.

Recovering from Excision Surgery / Follow-Up

  • Extra Strength Acetaminophen (Tylenol) can be taken as needed to control your pain. Most people have little pain after surgery. Your clinician also may prescribe other pain or antibiotic medications as needed.

  • You may be asked to avoid getting your bandage wet for up to 48 hours after surgery.

  • You may be asked not to swim or be in a pool, hot tub or the ocean until your top stitches are removed (typically 1 to 2 weeks). Avoiding water activities helps to reduce the risk of infection.

  • You may be asked to not participate in any activities that raise your blood pressure or heart rate (any exercise) for 48 hours after surgery. Limiting physical activity reduces the risk of bleeding complications and bruising.

  • There may be other activity restrictions, as determined on an individual basis, that may last for 2 or more weeks.

  • The area surrounding the operative site may be numb. Numbness is not uncommon and can last for many months. Usually felling returns to normal.​

  • You also may experience some skin tightness across the area of surgery. Tightness is normal and will improve with time as healing progresses.

  • Skin heals itself by producing a scar. Scar-free surgery is not possible. The method used to repair your wound will be selected to provide the best cosmetic and functional outcome.

  • Avoid travel for up to three weeks following your surgery in case you need to see your surgeon.

   You will be asked to return to the clinic 1 to 3 weeks after surgery. Your skin will be checked to make sure it is healing well. If you have stitches, they will be removed. Further surgical follow-up will be determined on an individual basis. Follow up with your general dermatologist per his or her recommendations for other skin concerns and conditions.

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Sorting Medicine

Post-Surgery Wound Care:

What is an Excision?

    Careful wound care following your surgery will help reduce scarring. The care of your surgical site depends on the location and the type of closure used. You will receive written instructions as well as an explanation from your clinician.

  • How long will I be at the clinic on the day of surgery?     

Plan to spend about 1 hour at the clinic for the surgery.

  • Should I expect any bruising?     

Bruising around the surgical site is common, especially in people who take an anticoagulant medication, such as aspirin or warfarin (Coumadin). Bruising is normally goes away in 7 to 10 days.

  • Why do I have so many stitches or why is my incision line so long?     

Most skin lesions are relatively circular or oval. Simply removing that circular or oval area and stitching it would leave an unsightly puckering of your skin. The surgical plan, which is designed to avoid puckering, often requires removing skin from other areas to properly repair or fill the defect and give a better cosmetic outcome. This requires more extensive stitching. Some skin lesions, such as cysts, do not always require removing extra skin. Your surgeon will discuss the surgical plan with you before your procedure.

  • Why is there a big surgical wound for what looked like a small  skin lesion?     

What you see on the top layer of your skin is only the “tip of the iceberg.” Often, the cancer extends much farther underneath the skin surface with roots that require a margin of normal-appearing skin to be removed with the portion of the skin lesion that is visible to ensure complete removal and avoid recurrence.

  • Will there be a scar?     

Unfortunately, there is no such thing as “scarless surgery.”  There will be a scar, but we care about giving you the best scar possible while also removing the lesion of concern in the most appropriate manner.

  • Is some dried blood on my bandage normal?     

A small amount of oozing in the early postoperative period is completely normal. If you have bleeding that wets through your bandage, apply direct pressure with another gauze pad over the surgical site for 15 minutes without peeking. If bleeding fails to stop, contact us at the telephone number on your wound care instruction sheet.

  • When will my bruising and swelling go away?

Bruising and swelling fade over several days to weeks. Some locations, like around the eye, may take a little longer than others. Products with arnica may help bruising to resolve faster.

  • Is it normal for the site to still hurt?

It is normal for the site to be mildly tender after surgery. Most of the tenderness improves within the first week. There may be some tightness or tenderness that takes longer, depending on the site of surgery. This will continue to improve gradually with time.

  • Is it still possible to get infected after my stitches are removed?

Infection is rare after the suture removal but still possible. To minimize the risk for infection avoid swimming or soaking the wound in water until the skin surface is fully healed. Showering is ok.

If you notice any signs of infection, please call our office (808-621-1000) or Dr. Flament’s cell phone (808-798-2377) if after clinic hours.

  • Increasing redness, warmth and swelling beyond the borders of the wound.

  • Foul smelling, purulent (white or yellow pus) drainage.

  • Increasing pain of the surgery site.

  • When will my scar start to fade?

The appearance of the scar and surrounding redness will decrease gradually over time but may last several months. Everyone heals differently and the final scar appearance depends on the individual’s ability to heal. If you are unhappy with the appearance of your scar, please see Dr. Flament to discuss. There are often options to improve scar appearance.

  • Why is my scar bumpy?

The scar is often raised in the first several weeks after surgery. This is done on purpose to give a more subtle permanent scar. Scars tend to contract and indent after surgery if this is not done. If the scar is still bumpy or the skin is still tight after one month, you may start gentle massage to the area a few times daily to encourage flattening and softening of the scar. Even though the wound may appear fully healed on the surface, it is not healed under the surface and has no strength yet.

  • What is one of the most important things I can do to help the scar to fade faster?

Sun protection of the surgical site! Wounds often darken or hyperpigment after surgery. This is more common if the site is exposed to the sun. To minimize this risk .If the area is not covered by clothing be sure to wear sunscreen (SPF >30 at least). Make sure the sunscreen is reapplied at least every 1-2 hours while the area is exposed to the sun. The sunscreens containing zinc oxide or titanium dioxide in the ingredients work best.

FAQs About Excisions

Skin Biopsy
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A surgical excision is a skin lesion or skin cancer treatment that surgically removes malignant moles, lesions and tumors from the skin along with a healthy margin around the tumor. Surgical excisions can be performed to treat basal and squamous cell carcinomas as well as melanomas.