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Surgical Procedures

Occasionally some skin conditions must be treated with surgical procedures. Dr. Brune has extensive training and experience in skin surgery and performs a number of procedures in our Corvallis office.

Skin Biopsy

Skin biopsy is a procedure in which a sample of skin is removed, processed, and examined under a microscope. Several different methods may be used to obtain a skin sample, depending on the size and location of the abnormal area of skin, called a skin lesion. The skin sample is placed in a solution, such as formaldehyde. At the lab the skin is processed and then examined under a microscope.

Skin biopsies most often are done to diagnose skin cancer, but also to diagnose certain rashes. Skin cancers are the most common type of cancers. Early diagnosis of a suspicious skin lesion and skin biopsy can help identify skin cancers and lead to early treatment.

Why Is It Done?

A skin biopsy is done to diagnose the following:

  • Skin condition (if it is not already clear what the condition is)
  • Skin cancer
  • Certain deep skin infections

How Do You Prepare?

Before a skin biopsy, tell your doctor if you:

  • Are taking any medicines, particularly anti-inflammatory medicines such as prednisone.
  • Anti-inflammatory medicines may change the way your biopsy looks under the microscope.
  • Are allergic to any medicines.
  • Have certain deep skin infections.
  • Have had any bleeding problems or are taking blood-thinning medicines, such as aspirin or warfarin (Coumadin).

Types of skin biopsy:

Shave biopsy is performed with either a small scalpel blade or a curved razor blade. The blade removes only a small portion of the lesion leaving the skin primarily intact. Electrocautery may be performed to heat the wound and stop any bleeding. Shave biopsies are frequently performed on lesions suspected to be basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).

Punch biopsy is performed with a round knife, similar to a very small cookie cutter. Stitches may be required to close the wound, though small punch biopsies may heal without stitches.

Excisional biopsy is performed with a scalpel. It is used to create an elliptical cut around the lesion and obtain some of the subcutaneous fat below the dermis. An excisional biopsy is frequently performed for lesions suspected to be melanoma. The wound created by an excisional biopsy is usually closed with stitches (sutures).



Electrodesiccation and Curettage

Electrodesiccation and Curettage (ED & C) is a surgical procedure commonly used in the treatment of some skin cancers (usually superficial ones) as well as precancerous spots that were resistant to other forms of treatment.

First the local area of the skin cancer is anesthetized. then, using a sharp, rounded tool called a curette, the doctor scrapes away the skin cancer. Finally, electricity is applied to the skin to cauterize the area with heat.

The cancer is not cut out so margins are not examined microscopically, but ED & C cure rates are similar to those of excisions in certain cases.



Excision (of moles, growths, cysts, keloid scars and skin cancers)

Surgical excisions are performed to remove a wide variety of skin lesions ranging from benign growths such as moles, cysts and lipomas to skin cancers. A margin of normal appearing skin is removed around the lesion to ensure complete removal; narrow margins for benign growths and wider margins for skin cancers.

How is Surgical Excision Performed?

Typically an elliptical shape of skin is removed. The resulting wound is repaired by loosening the surrounding skin and then closed in straight line using layers of deep and superficial sutures. The incision line will be longer than you may expect, as the final length is usually three times as long as the diameter of the wound.

On rare occasions, the wound may be repaired as follows:

  • Flap: The skin adjacent to the wound is elevated and moved to cover the defect. Flaps are typically used for larger wounds but can also be used for wounds in delicate areas, under tension, and to minimize distortion.
  • Skin graft: Skin from a different area of the body is used to cover the wound. This type of repair can take longer to heal but can provide excellent results.
  • Healing by granulation: The wound is left open and allowed to heal in on its own. Certain areas heal very well by this manner, although typically will take the longest to heal.

Surgical Excision is performed under local anesthesia. We suggest that you eat your normal breakfast unless otherwise specified. Please bathe or shower and wash your hair to minimize your risk of a surgical site infection.

What Can I Expect After the Surgery?

Pain

Most people will experience remarkably little discomfort after surgery. Usually Tylenol is sufficient to control the pain. If you would like a stronger prescription pain medication we will gladly prescribe this for you.

Bruising and Swelling

Bruising and swelling are common following surgery and usually lasts for several days. Applying ice in the first 24 hours helps reduce these symptoms.

Infection

The infection rate is very low. A preoperative antibiotic may be recommended to some patients. It is typical to develop some redness along the suture line, but if it becomes more extensive or if you develop increasing pain, swelling, drainage, please notify us immediately.

Bleeding

The risk of significant post-operative bleeding is very low. Upon completion of the surgery a pressure bandage will be placed on the wound. Small number of patients may have some post-operative bleeding as the epinephrine (adrenaline) in the anesthetic wears off. This usually can be stopped with direct pressure for 20 minutes. For any bleeding that is not controlled with pressure, we need to be notified immediately.

Numbness

At times, the area surrounding your operative site will be numb to the touch. This area of numbness may persist for several months or longer. In some instances it may be permanent. If this occurs, please discuss it with your physician at your follow-up visit.

Scar

Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. The scar will often be longer than what you may have anticipated because cancer that is underneath the surface is larger than what is visible before surgery.

Activity and Follow-up

You should plan on decreased activity and restrict travel for 1 week, and in some cases longer. We will discuss this after the surgery depending on the case.



Removal of Toenails

If you have a severe nail infection, fungus or other nail complication and treatments do not work, the recommended course may be removing the nail(s) to get rid of the underlying problem. Nonsurgical removal is occasionally an option, where a chemical is applied to the nail. However when surgical removal is necessary, we can perform the procedure in our office. The nail can grow back. If the infection fails to clear, however, it is also possible to treat the nail so that it cannot grow back.



Nail Biopsy

Nail biopsy is a surgical procedure in which a tissue specimen is obtained from the growth plate of a fingernail or toenail. A biopsy is typically performed to make or confirm a diagnosis or to surgically remove a skin lesion that is affecting the growth nail plate.



Intralesional Steroid Injection

Intralesional steroid injection may be indicated for the following skin conditions:

  • Alopecia areata
  • Discoid lupus erythematosus
  • Keloids/hypertrophic scars
  • Granuloma annulare
  • Other granulomatous disorders such as cutaneous sarcoidosis or granuloma faciale
  • Hypertrophic lichen planus
  • Lichen simplex chronicus (neurodermatitis)
  • Localised psoriasis
  • Necrobiosis lipoidica
  • Acne cysts (see nodulocystic acne)
  • Small infantile haemangiomas
  • Other localised inflammatory skin diseases