Shaving of epidermal or dermal lesions is a surgical procedure that involves cutting away at undesired benign growths on the skin. It is primarily used to remove benign skin lesions such as moles, seborrheic keratoses, actinic keratoses, and other such skin issues. It may also be referred to as “lesion biopsy,” “surface ablation,” or “cutaneous ablation.”
The procedure is commonly performed in a physician’s office with a scalpel, and requires minimal recovery time. The skin is typically frozen beforehand with a topical anesthetic to ensure the patient’s comfort during the procedure.
Shaving of epidermal or dermal lesions offers a wide array of benefits that range from medical to aesthetic. Some of the most significant advantages of this procedure include:
<li>Less invasive than other types of lesion removal</li>
<li>Significantly reduces the risk of infection and other complications</li>
<li>Effective in removing moles, seborrheic keratoses, and some other benign growths</li>
<li>Allows for quick recovery</li>
<li>Improves the appearance of the skin</li>
The results of shaving of epidermal or dermal lesions vary depending on the size, location, and severity of the lesion. Generally, the procedure will cause the affected area of the skin to become light, even in color. There may be minor scarring, but this usually fades over the course of several weeks. For the most part, the goal of the procedure is to produce an aesthetically pleasing result rather than an medically necessary one.
In some cases, a single shaving procedure may not fully remove the lesion. In such cases, additional treatments may be necessary. It is important to speak to your physician about what you realistically can expect the outcome of the procedure to look like.
Shaving of epidermal or dermal lesions is a relatively simple and low-risk procedure that can have a number of different beneficial effects. It is important to speak to a qualified physician prior to undergoing the procedure, however, as the results vary depending on the specific circumstances. The physician can help you set reasonable expectations and provide you with information on the risks and potential complications. With the right information and preparation, this procedure can be a safe and effective way to remove bothersome skin lesions.
Definition & Overview
Skin lesions are lumps, sores, or areas of the skin that are raised or have an abnormal appearance. Some are benign, but some can also be a sign of skin cancer. These can be removed for cosmetic purposes or as a part of a treatment plan through shaving (shave excision technique), a simple routine procedure performed under local anaesthesia.
Who Should Undergo and Expected Results
The shaving excision technique can be performed in patients with epidermal lesion (an abnormal growth on the upper layers of the skin) and dermal or subcutaneous lesions (affect the inner layers of the skin). Examples are:
- Crusts or scabs
- Skin ulcers
Lesions may occur as a single abnormal growth or in clusters. They are also categorised based on their appearance, such as:
- Linear lesions, or straight lesions
- Annular lesions, or rings with central clearing
- Target lesions, or rings with central features
- Reticulated lesions, or lacy and networked lesions
- Herpetiform, or groups of papules and vesicles similar to a herpes simplex infection
- Zosteriform, or clusters of lesions similar to a herpes zoster infection
- Nummular lesions, or circular ones
The shaving procedure can effectively remove skin lesions that are relatively small and uncomplicated. It is a simpler and less expensive alternative to a full-thickness skin excision, which is a more invasive method reserved for larger and more complex lesions. The procedure produces minimal scarring and does not require stitches.
Although effective, the procedure does not guarantee against future lesion growth.
How is the Procedure Performed?
Shave excision of epidermal or dermal lesions is performed under local anaesthesia, which works in two ways for this procedure; aside from making the lesion site numb, it also causes the lesion to rise upwards, making it easier for the doctor to remove it through a simple shaving technique. The doctor can then proceed to cut off the lesion by making several horizontal cuts using a sharp razor. Due to the anaesthetic used, patients typically only feel a pulling sensation.
The shaving procedure is followed by electrosurgical feathering, which is performed to improve the appearance of the skin after the lesion is removed, to prevent scarring, to smoothen the edges of the wound and most importantly, to make sure no traces of the growth remain on the surface of the skin. This is done with the use of a dermal loop electrode.
The doctor will then apply aluminium chloride hexahydrate on the wound to control bleeding, if any, as well as an antibiotic ointment to soothe the area, promote faster healing, and prevent infections. The wound is then covered with a sterile bandage for protection.
The wound should be kept dry for 24 hours, and the patient will be instructed to apply a topical antibiotic on the wound at least twice a day as the wound heals.
Possible Risks and Complications
Patients who undergo shaving of epidermal or dermal lesions can expect to feel some discomfort, similar to a burning sensation, at the site where the lesion was removed. If the pain is bothersome, they can take over-the-counter pain relievers, such as ibuprofen or acetaminophen, when and as needed.
There is also a risk of scarring, which patients can try to reduce by applying a topical silicone gel or a vitamin A cream on the wound. The scar may appear bright red during the first few weeks, but tends to lighten in appearance as time goes by.
Another risk is skin discolouration, which can occur if the wound becomes permanently darker due to sunburn. This is why it is important to use a bandage and to avoid too much exposure to sunlight as the wound is healing.
Also, although infection is rare, it is possible. Signs of an infection include extreme tenderness, swelling, increasing redness, and a pus discharge.
Lastly, there is a risk that the lesions will grow back following the procedure.
MacNeal RJ. “Description of skin lesions.” Merck Manual. http://www.merckmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/description-of-skin-lesions
Goldberg LH, Segal RJ. “Surgical pearl: a flexible scalpel for shave excision of skin lesions.” Journal of the American Academy of Dermatology. 1996. 35(3):452-453. http://www.jaad.org/article/S0190-9622(96)90612-X/abstract