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Excision – Definition, Procedure & Uses

Excision is a surgical procedure in which tissue or a lesion is completely cut out and removed. It is used to treat tumors, cysts, and other diseased tissue.

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Things worth knowing about "Excision"

Excision is a surgical procedure in which tissue or a lesion is completely cut out and removed. It is used to treat tumors, cysts, and other diseased tissue.

What is an Excision?

An excision (from the Latin excisio, meaning to cut out) is a surgical procedure in which tissue, a lesion, a tumor, a cyst, or another abnormal structure is completely removed from the body. It is one of the most fundamental techniques in surgery and is applied across virtually all medical specialties.

Unlike an incision (a cut made to access tissue) or a standard biopsy (removal of a small tissue sample for analysis), an excision aims to fully remove the affected tissue, often including a margin of healthy surrounding tissue known as the surgical margin or resection margin.

Indications and Areas of Use

Excisions are performed for a wide range of medical conditions. Common indications include:

Skin lesions: Removal of moles (melanocytic nevi), basal cell carcinomas, squamous cell carcinomas, or malignant melanomas
Benign growths: Cysts, lipomas, fibromas, or papillomas
Infectious or inflammatory foci: Abscesses, infected cysts, or chronically inflamed tissue
Oncological surgery: Removal of cancerous tumors, typically with a defined safety margin of healthy tissue
Gynecology: Removal of uterine fibroids, ovarian cysts, or abnormal cervical tissue (e.g., conization)
Orthopedics and general surgery: Removal of ganglion cysts, meniscal fragments, or necrotic tissue

How is an Excision Performed?

The procedure varies depending on the location, size, and nature of the tissue to be removed. A typical excision follows these steps:

Preparation: Skin disinfection, sterile draping of the surgical field, and positioning of the patient
Anesthesia: Local anesthesia, regional nerve block, or general anesthesia depending on the scope of the procedure
Tissue removal: The surgeon cuts out the target tissue using a scalpel, electrocautery device, or laser, often with a defined margin of healthy tissue
Hemostasis: Bleeding is controlled using electrocautery coagulation or suture ligatures
Wound closure: The wound is closed with sutures, staples, or adhesive strips for smaller incisions
Histopathological analysis: The removed tissue is routinely sent to a pathology laboratory for microscopic examination

Excisional Biopsy

A specific and common form is the excisional biopsy: the entire lesion is removed and simultaneously submitted for histological analysis. This approach combines diagnostic and therapeutic purposes in a single procedure and is frequently used for suspicious skin lesions or enlarged lymph nodes.

Risks and Possible Complications

As with any surgical procedure, excision carries certain risks:

Post-operative bleeding or hematoma (bruising)
Wound infection
Scarring or keloid formation
Nerve injury in deep excisions
Incomplete removal (positive resection margins) potentially requiring re-excision
Allergic reactions to anesthetic agents or suture materials

Aftercare and Follow-Up

Following an excision, regular wound checks are essential. Depending on the type of tissue removed and the histological findings, additional treatments such as radiation therapy, chemotherapy, or close monitoring may be required. The results of the pathological examination are central to determining the next steps in treatment.

References

Townsend, C. M. et al.: Sabiston Textbook of Surgery, 21st Edition, Elsevier, 2022.
World Health Organization (WHO): Guide to Cancer Early Diagnosis. WHO, Geneva, 2017. Available at: https://www.who.int
Goldsmith, L. A. et al.: Fitzpatrick's Dermatology in General Medicine, 9th Edition, McGraw-Hill, 2019.

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