Staged Excision at Florida Dermatology Specialists

This procedure is generally for Lentigo Maligna or Melanoma in situ usually on the head and neck.  The patients need to plan for a somewhat flexible schedule for the week.  We start these at the beginning of the week in the morning only and continue until wound closure later in the week. For the Palm Beach Gardens office, we only start staged excisions on Mondays.  For the Stuart office, we only start staged excisions on Tuesdays.

This early melanoma is removed on the first day of the procedure with a small margin.  The tissue is specially marked and sent to the pathology lab for rushed processing in a specific manner where the entire peripheral and deep margin are evaluated by the pathologist.  The pathologist can also use special tissue stains we do not have available in the office to highlight the cancerous cells.

The wound is left open and not closed on this first day.  The wound is bandaged, and the patient is sent home.

The results are usually available from the pathology lab in about 30-36 hours.  We will communicate those results as soon as available.

If not all of the melanoma has been removed, we will usually see the patient the following day, or two days later, for further removal and then further processing.  The wound is again left open.  

This process is then repeated until the melanoma has been fully removed.  It usually takes one or two sessions to remove it, although sometimes more may be required.

Once the skin cancer has been removed, the doctor will review the options for healing.  Most commonly, the wound is closed with stitches.  Most often, the wound is closed into a line of stitches.  Sometimes, some nearby skin may need to be moved to help close the wound, which is called a skin flap.  Other times, skin may need to be moved from a more distant site, which is a skin graft.  The doctor can safely perform all these in the office.  Sometimes, we allow the wound to heal on its own.  It sometimes takes a long time to heal on its own, but may be a preferred option for some patients in some select circumstances.

Some patients may ask if they need to see a plastic surgeon. Your doctor is specially trained in Mohs surgery and reconstruction, trained through the American College of Mohs Surgery, and highly skilled and qualified to perform your surgery.  If you would like, we would be happy to set up a consultation in the office to discuss this further.  

Activity like vigorous exercise, tennis, or golf may be limited during that time until stitches come out.  In addition, there can be no underwater submersion until the stitches have been removed.  This means no swimming or baths until then.  There will be a pressure bandage on the site.  It can be removed 48 hours after surgery.  There is often little required wound care after that.  Showering will be fine after the pressure bandage has been removed, which is generally 48 hours after surgery.  

The risks of the surgery are small, including bleeding, low risk of infection, 3% recurrence of the cancer, and a thin scar.

We recommend for all staged excision patients to have a driver if the surgery will be performed on the face.  There will likely be a bulky bandage on the area that may obstruct or partially obstruct vision for driving.

You will also need to review Preoperative Concerns and Protocols.