Excision is a common medical procedure that involves the surgical removal of tissue, a growth, or a lesion, such as a mole, cyst, or skin cancer. This process separates the abnormal tissue from the surrounding healthy tissue using a scalpel or other cutting instrument. The goal is to entirely remove the target area, often for diagnosis or treatment. This surgical approach is performed to ensure the complete elimination of a problematic growth, and the site’s appearance changes significantly through the long-term healing process.
The Purpose and Preparation for Removal
Excision is performed for two primary reasons: to obtain a complete specimen for diagnosis, known as an excisional biopsy, or to cure a condition by removing the entire diseased area. For instance, skin cancers are removed with a surrounding margin of healthy tissue to minimize the risk of recurrence. The medical professional first marks the area to be removed, ensuring the boundary encompasses the lesion and the necessary safety margin. Before the procedure, the site is cleaned with an antiseptic solution to reduce the risk of infection. Local anesthesia is then administered by injection directly around the lesion, temporarily numbing the skin and underlying tissue. Patients often describe a brief stinging or burning sensation during the injection, which quickly gives way to numbness.
The Appearance of Tissue Removal
Once the area is numb, the surgical removal begins with an incision shaped like an ellipse or a football, which allows for a clean, linear closure. The surgeon uses a scalpel to cut through the skin and into the underlying fat layer, lifting the entire marked segment of tissue away from the body. This surgical defect appears as an open, oval-shaped depression in the skin once the tissue is removed. Bleeding is managed using cauterization, which involves using a heated probe or electrical current to seal small blood vessels within the open wound. This process may leave a slightly charred or darkened appearance on the exposed tissue surfaces. The resulting open wound is a temporary depression that must be closed to begin the healing process.
Immediate Post-Procedure Appearance
Immediately after the tissue is removed, the open surgical defect is closed, typically using sutures. The closed incision line will be visibly raised, appearing slightly tighter than the surrounding skin because of the tension required to bring the wound edges together. Small puckers of excess skin, sometimes called “dog ears,” may be present at the ends of the linear incision, which usually flatten out over time. The sutures are either visible on the skin surface, requiring removal, or placed just beneath the skin using dissolvable material. The fresh wound site will show signs of swelling and bruising due to the surgical trauma. A sterile dressing or pressure bandage is applied over the incision line to protect the wound, absorb any minor seepage, and provide gentle compression.
The Long-Term Healing and Scarring Process
The visual transformation of the excision site continues for many months as the body repairs the injury. External sutures, if used, are typically removed within one to three weeks, depending on the location of the incision. After the stitches are out, the scar enters the maturation phase, marked by the formation of new collagen fibers. In the initial months, the scar will appear raised, firm to the touch, and dark pink or reddish-purple as new blood vessels form to support the healing tissue. This redness gradually fades as the collagen fibers realign and the blood supply decreases, a process that can take 9 to 18 months to complete. The final appearance of the scar is a pale, flat line that is thinner and less noticeable. Factors like the location of the excision, the tension on the skin, and an individual’s genetic predisposition all influence whether the final mark will be a fine line or a more prominent, thickened scar.