Wide local excision (WLE) is a surgical procedure used to remove abnormal or diseased tissue. It involves the precise removal of a lesion or tumor, along with a surrounding border of healthy tissue. The goal is to achieve complete removal while preserving as much healthy tissue as possible.
What is Wide Local Excision Surgery?
WLE involves removing a problematic area of tissue, such as a tumor or lesion, along with a specified margin of normal, healthy tissue. This surrounding healthy tissue is called a “clear margin” or “negative margin.” Including this margin helps ensure all cancerous or suspicious cells are removed, reducing the likelihood of recurrence at the surgical site. The amount of normal tissue removed varies based on the lesion’s size and depth.
This procedure is performed for malignant or suspicious lesions, including skin cancers like melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). For early-stage melanoma, WLE can often be curative. It is also used for other soft tissue lesions.
The Surgical Process
Anesthesia is administered before the wide local excision. Depending on the lesion’s size, location, and surgical extent, local or general anesthesia may be used. Local anesthesia numbs the specific area, allowing the patient to remain awake, while general anesthesia induces a sleep-like state. The surgeon cleans the site and makes an incision, often elliptical, to encompass the lesion and its predetermined margin of healthy tissue.
After the lesion and clear margin are removed, the wound closure method is determined. For smaller excisions, wound edges are closed directly with sutures. If a larger area of skin is removed, direct closure may not be feasible. Techniques like a skin graft, transplanting healthy skin from another body part, or a skin flap, using adjacent tissue with its own blood supply, may be necessary.
Once closed, the removed tissue is sent to a pathology laboratory. Pathologists examine the tissue under a microscope to confirm the diagnosis, assess lesion characteristics, and verify clear margins. The results help guide further treatment decisions.
Before and After the Procedure
Preparation for wide local excision surgery involves several steps. Patients may be advised to adjust certain medications, especially blood thinners, in the days leading up to the procedure to minimize bleeding risk. If general anesthesia is planned, specific instructions regarding fasting from food and drink for a period of hours before surgery will be provided. Patients are also advised to arrange for transportation home after the procedure, particularly if they receive general anesthesia or pain medications that impair driving ability.
Immediately following the procedure, patients can expect some discomfort, swelling, and bruising at the surgical site. Pain management involves prescribed pain medications or over-the-counter options like acetaminophen or ibuprofen. Wound care instructions are provided, often involving keeping the incision clean and dry, and avoiding direct water exposure for a specified period, typically 24 to 48 hours. Dressings may need to remain in place for a day or two, and patients are advised on how to change them and apply any recommended ointments.
It is important to monitor the surgical site for signs of potential complications, such as infection or excessive bleeding. Symptoms of infection can include increased redness, warmth, swelling, significant pain, or discharge from the wound, along with a fever. Patients should also be aware of potential fluid collection (seroma) or blood collection (hematoma) under the wound, which can cause swelling and firmness. Contacting the healthcare provider promptly if any concerning symptoms arise.
Follow-up and Pathology Results
After wide local excision, the pathology report confirms the removed lesion’s diagnosis and provides detailed characteristics, including cell type and aggressiveness. The report also indicates whether “clear margins” were achieved, meaning no diseased cells were found at the edges of the removed tissue. Achieving clear margins suggests the entire lesion was successfully removed, lowering the risk of the condition returning.
If the pathology report indicates unclear margins, further treatment, such as an additional wide local excision, may be recommended to ensure complete removal. Follow-up appointments monitor surgical site healing, discuss pathology results, and determine subsequent treatment plans or ongoing surveillance. These appointments are for wound checks, suture removal if needed, and to assess overall recovery. Long-term surveillance may also be advised, especially for conditions like melanoma, to detect potential recurrence or new lesions early.