Wide Local Excision (WLE) is a surgical procedure designed to remove a localized area of abnormal tissue. This technique involves excising the lesion along with a surrounding rim of seemingly healthy tissue. The goal is to ensure the entire diseased area is removed in a single, controlled operation. WLE is typically performed on an outpatient basis.
Defining Wide Local Excision
Wide Local Excision is performed after an initial diagnostic biopsy confirms the presence of malignant cells, such as in skin cancer. It serves as the definitive treatment intended to clear the area of any remaining cancerous tissue or microscopic extensions of the disease. The procedure relies on the concept of the “wide margin,” which is the layer of healthy tissue removed alongside the original lesion.
This margin is precisely measured and removed to reduce the risk of the cancer recurring at the original site. The exact width is determined based on the specific characteristics of the tumor, such as its thickness. For instance, in treating melanoma, the margin width often depends on the tumor’s Breslow depth. Thinner melanomas require smaller margins than thicker ones.
Current guidelines suggest that for a very thin melanoma, the margin may be as small as five millimeters, while a thicker melanoma may require one or two centimeters. This careful measurement ensures the surgeon removes enough tissue to be effective while also preserving healthy skin and function.
The WLE Procedure: Steps and Technique
The WLE procedure is often performed in a clinical setting under a local anesthetic, which numbs the surgical site while the patient remains awake. Before the incision, the surgeon uses a marking pen to outline the area to be excised. This outline incorporates the primary lesion or biopsy site and the required wide margin.
The incision is commonly shaped like an ellipse or a football to facilitate a straighter, cleaner closure that minimizes skin puckering. The surgeon excises the marked tissue, often cutting down to the underlying muscle fascia for deeper lesions, ensuring thorough removal. This excised tissue block is then carefully oriented and sent immediately to a pathology laboratory for detailed analysis.
The pathologist examines the tissue under a microscope, paying particular attention to the edges of the specimen, known as the surgical margins. If no cancerous cells are present at the edges, this indicates a “clear margin.” If cancer cells are found at the margin, the patient may require a subsequent procedure to remove additional tissue.
Following the excision, the surgical defect must be closed, which varies depending on the size of the removed tissue. For smaller excisions, the surrounding skin is brought together and closed with sutures, a process called primary closure. If a large area was removed and primary closure is not possible, the surgeon may perform a skin graft or use a local skin flap to cover the wound. A skin graft involves transplanting a thin layer of skin from another area of the body, while a flap uses neighboring tissue that retains its original blood supply.
Recovery and Follow-Up Care
Recovery from a Wide Local Excision is generally straightforward. Patients experience mild discomfort at the surgical site, which is usually manageable with over-the-counter analgesics such as acetaminophen or ibuprofen. The surgical wound is covered with a sterile dressing, and patients receive specific instructions on wound care, including how and when to change the dressing and when it is safe to shower.
Patients are advised to limit strenuous activities, heavy lifting, and activities that stretch the surgical site for one to two weeks. This promotes proper healing and prevents the wound from opening. Depending on the type of closure, external sutures may need removal at a follow-up appointment, typically scheduled between one and three weeks after the surgery. Dissolvable sutures placed beneath the skin do not require removal.
The follow-up process involves waiting for the pathology report on the excised margins, which usually takes about five to seven business days. This report dictates whether the procedure was curative or if further treatment is necessary. Subsequent appointments check the wound’s healing progress, discuss the final pathology results, and outline any required long-term surveillance schedule.