II. Indications: Elevated (exophytic) neoplasms
- Skin Tag
- Non-pigmented Nevus
- Keratocanthoma
- Dermatofibroma
- Seborrheic Keratosis
- Actinic Keratosis
- Cutaneous horn
- Possible small localized low-risk cancer
- Basal Cell Cancer
- Squamous cell cancer
III. Contraindications
IV. Technique
- Prep lesion with Povidone-Iodine (Betadine) or Chlorhexidine (Hibiclens)
-
Local Anesthesia with intradermal Local Lidocaine
- Adequate Anesthesia requires 1 cm wheal around lesion
- Anesthesia also raises lesion above skin plane
- Shave tangential to skin with #15 blade or Dermablade (double-edged razor blade)
- Consider using Radiofrequency to smooth edges
- Effective at reducing scarring risk on face
- Use small electrosurgical loop electrode
- Set unit to 1.5 or 2.0
- Stabilize hand against skin with pinky finger
- Use shallow short strokes to smooth lesion edges
-
Hemostasis
- Aluminum Chloride for face and mild bleeding
-
Monsel's Solution or Silver Nitrate can be used on non-facial areas
- Risk of skin staining
V. Interpretation: Biopsy
- Benign positive wound edges
- Does not usually require re-excision
- Observe for lesion recurrence
- Positive wound edges for Basal Cell Cancer
- See Basal Cell Carcinoma for management
- Positive wound edges for squamous cell cancer
- Perform full-thickness re-excision
-
Melanoma transected
- Never Shave Biopsy pigmented lesions!
- Accurate staging of transected Melanoma not possible
- Refer to skin-cancer specialist
- Transected Melanoma assumed intermediate to high risk
- Wide local excision with Sentinel Node biopsy
- Work-up may include chest, abdominal and skull CT
- Lymphoscintigraphy may be needed to define drainage
- Patient seen q3 months for 3 years, then q6 months
- References
VI. Post-Operative Care: Avoid scab formation
- Promote moist Wound Healing for 1 week
- Apply ointment to incision site frequently
- Consider petrolatum (e.g. Vaseline Gauze)
- Consider topical Bacitracin
- Consider non-Antibiotic (e.g. Aquaphor)
VII. Complications
- Scarring (higher risk on the face)
- Hypertrophic Scar in areas of excessive skin tension