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EXCISION OF SKIN LESION AND CYST

Preprocedural planning

  • Clinical assessment

    • History and examination​

      • What is this lesion?​​

      • Why does it need to be excised?

      • Are there any less invasive methods of treatment?

  • Consent

    • Obtaining written patient consent for the procedure, based on your understanding and clinical assessment of the reason for the procedure, benefits and risks, and allowing time of the patient to clarify questions about the procedure​​

  • Instruments and equipment

  • Choose the most suitable local anaesthetic for the procedure​

Preprocedural planning

Excision of skin lesion

  • Mark skin lesion with surgical pen

    • Take into account margins for excision in lesions s​uspicious of skin cancer

    • Extend marking into ellipse orientated along Langers' lines to ease skin closure

  • Administer local anaesthetic​ subcutaneously

  • Prep skin with Chlorhexidine or Vidine and apply sterile drapes

  • Incised skin with scalpel along the marked ellipse into fat

  • Using a pair of toothed forceps in your non-dominant hand, lift an edge of the ellipse up and using the heel of the scalpel-bearing (dominant) palm, apply gentle pressure on the surface of the skin away from the lifted ellipse edge to create gentle traction across the fatty layer

  • Simultaneously, complete the excision of the skin lesion by taking even cuff of fat by gentle sharp incisions with the scalpel blade angled parallel with the angle of lift of the skin ellipse

    • The incision at this point should require little force as this is aided by good traction

  • Place the excised ellipse in the histology pot​

    • Determine if an orientation suture is required beforehand

  • Haemo​stasis with bipolar forceps

  • Primary suturing of the wound with sutures of the appropriate size

Excision of skin lesion

Excision of cystic lesion

  • Mark edges of the cyst with surgical pen and ellipse punctum (if visible)​

    • Orientate ellipse along Langers' lines to ease skin closure

  • Administer local anaesthetic​ subcutaneously to cover both the marked edges of the cyst and ellipse

  • Prep skin with Chlorhexidine or Vidine and apply sterile drapes

  • Incised skin with scalpel along the marked ellipse carefully until the wall of the cyst is visible

  • Using a pair of toothed forceps in your non-dominant hand, lift an edge of the ellipse up and using the heel of the scalpel-bearing (dominant) palm, apply gentle pressure on the surface of the skin away from the lifted ellipse edge to create gentle traction across the fatty layer

  • Simultaneously, gently dissect the cyst wall from the surrounding tissue using a pair of dissecting scissors

    • The dissection at this point should require little force as this is aided by good traction, which may need adjustment with an assistant depending on where you are dissecting

  • Place the excised cyst in the histology pot​​

  • If the cyst is ruptured, attempt to excise all remnants of the cyst wall and remove any of the cyst contents

    • If there are residual cyst contents, irrigate wound with 0.9% NaCl​

  • Haemo​stasis with bipolar forceps

  • Primary suturing of the wound with sutures of the appropriate size

Excision of cystic lesion
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