Skin lesion removal encompasses the surgical excision of moles, cysts, lipomas, fibromas, suspicious lesions, and malignant skin tumors, with concurrent aesthetic reconstruction of the operated area. The plastic surgeon is the ideal specialist for these procedures, combining oncological competence in radical lesion removal with the ability to reconstruct the defect using techniques that minimize scarring impact, particularly important in exposed areas such as the face.
The most common skin lesions treated by plastic surgeons are: • Moles (nevi): benign or suspicious pigmented lesions requiring removal for prevention or cosmetic reasons. Atypical moles are removed to rule out melanoma • Skin carcinomas (basal cell and squamous cell): the most frequent malignant skin tumors, requiring excision with safety margins and reconstruction • Sebaceous and epidermoid cysts: subcutaneous nodules containing sebaceous material or keratin, which can become inflamed and infected • Lipomas: benign fatty tissue growths, soft and mobile, removed when they increase in size or cause discomfort • Fibromas and dermatofibromas: fibrous skin growths, generally benign, removed for cosmetic or diagnostic reasons
• Suspicious moles presenting atypical criteria (asymmetry, irregular borders, uneven color, increasing size, evolution), to rule out melanoma • Cosmetically bothersome moles or those causing mechanical irritation (friction with clothing, shaving) • Basal cell and squamous cell skin carcinomas requiring surgical excision with adequate oncological margins • Recurrent or inflamed sebaceous cysts, to remove the capsule and prevent further inflammation • Large or growing lipomas, for cosmetic or diagnostic purposes • Any newly appearing skin lesion or one that has changed its characteristics over time
• Uncontrolled coagulation disorders, which increase the risk of intra and postoperative bleeding. If necessary, surgery is planned in collaboration with the hematologist • Active skin infections in the operative area: for infected cysts, the infection is first treated with antibiotics and drainage, postponing definitive excision until the infection has resolved • Anticoagulant therapies: managed in agreement with the treating physician, with possible suspension or perioperative bridging • Documented allergy to local anesthetics, a rare condition requiring the use of alternative anesthetics
Procedure duration varies based on the size, location, and nature of the lesion: excision of a small mole takes 15-20 minutes, while removal of a skin carcinoma with local flap reconstruction may take 30-60 minutes. For multiple lesions or tumors requiring complex reconstructions (rotation flaps, skin grafts), time may extend to 1-2 hours. Recovery requires 5-14 days for suture removal, with outpatient dressing changes in between.
The vast majority of procedures are performed under local anesthesia, making the procedure completely painless while allowing the patient to remain alert and cooperative. Local anesthetic (lidocaine with epinephrine) is infiltrated around the lesion and takes effect within minutes. For multiple excisions, large lesions, or particularly anxious patients, light conscious sedation can be added. General anesthesia is reserved for exceptional cases with complex reconstructions or pediatric patients.
Excision results are definitive: the lesion is completely removed and sent for histological examination. The resulting scar goes through an initial phase of redness and firmness in the first 2-3 months, then gradually fades. The definitive aesthetic result is appreciated after 6-12 months, when the scar reaches its final maturation, becoming a light, thin line. The histological examination results, available in 7-15 days, confirm the benign or malignant nature of the lesion and guide any further treatments.
Yes, histological examination is always strongly recommended and represents the gold standard diagnostic test for every excised skin lesion. Only microscopic tissue analysis can confirm with certainty the nature of the lesion (benign, precancerous, or malignant) and verify that excision margins are free from disease. For malignant skin tumors, histological examination is essential to define the histological type, thickness, possible invasion, and plan appropriate oncological follow-up.
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