Seeing a skin procedure on my schedule always makes
my day. I enjoy providing patients
with small epidermal (sebaceous) cysts and worrisome lesions the convenience of
removal in the office.
Traditionally, epidermal cysts are removed by making an
incision parallel to the skin lines over the widest part of the cyst. The cyst is dissected away from the
subcutaneous tissue, and after it’s removed the incision is sutured.
Traditionally, worrisome skin lesions are removed by inking
an ellipse (1:3 ratio of width to length ensures optimal closure) around the
lesion. The ellipse is then incised and
lifted away from the subcutaneous tissue and closed with sutures.
In the last year, I’ve learned about an alternative
technique for each of these procedures.
They are much faster than the traditional methods above.
Minimal excision technique for epidermal cysts
Make an incision of 2-3 mm over the cyst. Then use a hemostat to keep this incision
open and squeeze out all of the cyst’s contents using your thumbs (wear eye
protection!). Use the hemostat to lift
out the cyst shell. No sutures are
necessary given the tiny size of the incision.
(Avoid this technique for cysts that are/were infected or
inflamed, as the adhesions surrounding the cyst will make lifting out the cyst
shell impossible.)
Thorough technique description and excellent pictures here: http://www.aafp.org/afp/2002/0401/p1409.html
Saucerization (“scoop”) excision for worrisome skin
lesions
This procedure uses a common shave biopsy (razor) blade but
“scoops” deep into the skin. The blade
should enter the skin at a 45-degree angle and penetrate to at least the
mid-dermis.
Thorough technique description and excellent pictures here:
When described to me within the last year, both of these
procedures were billed as “new,” yet the AFP
articles above cite sources that are more than 10 years old. It was a bit disconcerting to find how out of
date my surgical techniques were.
Given that the dissemination gap between research-based practice
recommendations and the actual implementation into clinical practice is around 20
years, though, perhaps I shouldn’t have been so surprised.
Are you using the minimal excision technique and/or saucerization in your practice? I welcome comments about when you learned about these techniques and how they're working. Or, if not yet, would these techniques change your practice?
