How and Why Excisions Are Performed During a Surgery

Excision means "to surgically remove." This term is used in reference to removing a mass using a scalpel, laser, or another instrument. During an excision, the entire mass is completely removed and not just a part (as is done in a biopsy).

While the term "excise" is often used to describe a large range of procedures that remove tissue during surgery, the precise use of the term means removing an entire structure using some type of cutting instrument. A lumpectomy is an example of an excisional biopsy that removes the entire growth versus a biopsy that takes just a sample of the lump to study.

Although the term "excise" is often used to describe procedures that are used to treat cancer, it is not exclusive to the treatment of cancer. Tissues may need to be removed for a variety of reasons, and while cancer is certainly one of those reasons, there are many other medical problems that may require excision.

Examples

In addition to the aforementioned lumpectomy, appendectomy, and cholecystectomy, there are other examples of surgical excisions, such as:

• Excisional skin biopsy: Typically recommended for certain skin cancer, including low- and high-risk basal cell carcinoma, low- and high-risk squamous cell carcinoma, Merkel cell carcinoma, and thin melanoma
• Tumor craniotomy with excision: A surgical procedure involving the removal of a section of bone from the skull (called a craniotomy) to access the brain for the purpose of excising a tumor, whether benign or cancerous
• Myxoma excision: The surgical removal of a benign heart tumor called a myxoma typically found in the left atrium of the heart that accounts for roughly 50% of all primary heart tumors
• Excision of venous malformations: One of two treatment approaches (alongside sclerotherapy) used to remove lesions in blood vessels that are present at birth but can grow over time to cause painful hardened blood clots called phleboliths
• Excision of bone tumors: A surgical procedure used not only to remove malignant (cancerous) bone tumors but also benign tumors that can become malignant and increase the risk of a pathologic bone fracture
• Functional endoscopic sinus surgery with polypectomy: A minimally invasive procedure using a flexible endoscope to locate and remove a soft benign growth, called a polyp, from a nasal passage when conservative treatments like steroids fail to provide relief
• Colonoscopy with polypectomy: A common procedure performed during the endoscopic examination of the colon, called a colonoscopy, during which benign polyps are removed preemptively on the off chance they may eventually turn cancerous
• Endometrial excision: The complete removal of uterine tissue overgrowth in females with endometriosis
• Orchiectomy: The surgical removal of one or both testicles, called an orchiectomy, which is mainly used to treat testicular cancer or advanced prostate cancer
• Acromioclavicular joint excision: A surgical procedure used to remove a damaged and painful acromioclavicular joint (ACJ)—located where the clavicle (collarbone) and scapula (shoulder blade) meet—without destabilizing the shoulder itself

Who Performs Excisions

Surgical excisions are typically performed by surgeons, some of whom are general surgeons who can perform procedures like appendectomies and cholecystectomies and others of whom are specially trained and certified to treat specific organ systems.

Specialists include neurosurgeons who treat diseases of the brain and central nervous system, surgical oncologists who treat cancer, orthopedic surgeons who specialize in bone and joint disorders, and cardiothoracic surgeons who treat diseases of the heart, lungs, esophagus, and other organs in the chest.

For example, adjuvant cancer therapy may be provided by a medical oncologist and/or radiation oncologist following treatment by a surgical oncologist. By contrast, neoadjuvant therapy may be recommended before surgery to help shrink a tumor.

Procedures

Surgical excisions may be performed on an inpatient or outpatient basis. They may involve local, regional, or general anesthesia or no anesthesia at all. Some are performed as a traditional open surgery involving a scalpel and a large incision, while others are performed laparoscopically using specialized tools and smaller "keyhole" incisions.

The range of techniques used for surgical excision are vast and vary by the body part and condition being treated. These include:

• Excisional skin biopsy: The procedure, also known as a wide local incision, involves the removal of a tumor and some normal tissue around it (called the clinical margin). The size of the margin depends on the thickness of the tumor. In some cases, skin grafting or a skin flap is used to cover the wound, while others wound are simply closed with sutures (stitches).
• Tumor craniotomy with excision: Almost all tumor craniotomies are performed with a computerized navigation technique, known as stereotaxy, to improve the accuracy of the surgery and reduce the size of the incision. The removal of the tumor involves specialized scalpels and scissors, a suctioning device (called an ultrasonic aspirator), and special microscopes.
• Myxoma excision: Surgical excision is the only form of treatment of myxomas. Because myomas are very fragile and vulnerable to rupture, their removal often requires open surgery to provide clearer access to the chambers of the heart.
• Excision of venous malformations: Surgical excision of venous malformations involves the removal of abnormal veins as well as some of the tissues surrounding them. Sclerotherapy (which involves the injection of chemicals into a vein to cause them to shrink) is often used beforehand to reduce bleeding and make the malformation easier to remove.
• Excision of bone tumors: The removal of a bone tumor is often followed by radiation and/or chemotherapy to prevent the spread of cancer and help preserve the limb (referred to as limb-salvage surgery). A metallic plate or transplanted bone may be used to help stabilize and strengthen the bone.
• Functional endoscopic sinus surgery with polypectomy: The procedure is typically performed under general anesthesia with a rigid endoscope. Once the polyp is located, forceps, cutting tools, or a microdebrider (a cylindrical powered shaver)( can quickly remove the growth.
• Colonoscopy with polypectomy: A common procedure performed during the endoscopic examination of the colon, called a colonoscopy, during which benign polyps are removed preemptively on the off chance they may eventually turn cancerous
• Endometrial excision: These procedures are often performed with robot-assisted laparoscopic surgery to remove growths and scar tissue or to destroy them with intense heat (referred to as fulguration or cauterization). The aim of the surgery is to leave as much tissue unharmed to better increase the chances of fertility following the operation.
• Orchiectomy: An orchiectomy involves an incision just above the pubic area, after which the testicle and spermatic cord are gently removed from the scrotum through the opening along with the entire tumor. The operations can be performed either laparoscopically or as open surgery.
• Acromioclavicular joint excision: The surgery is typically used when the joint is severely damaged by osteoarthritis or an injury. Using an arthroscope and laparoscopic tools, the surgeon will first shave and smooth worn surfaces of the joint before cutting and removing a piece of the collarbone. The joint will remain stabilized by ligaments that bridge the severed section of bone.

The indications for excisions can also vary, with some conditions requiring alternate approaches due to the stage of the disease, the size or location of a tumor, the general health of the individual, and other factors.

For example, stage 4 cancers are often not removed because doing so may not improve survival compared to other forms of treatment, such as chemotherapy or immunotherapy.

A Word From Verywell

The word "excision" may seem serious, but it's not necessarily so. The removal of a mole for cosmetic purposes is also a form of excision. In the end, an excision only indicates that a part of your body is being removed surgically.

If you are to undergo any surgical excision—or any procedure ending with -ectomy—ask your doctor why it is needed, what is involved, and if there other less invasive options that may be just as effective. In the end, you are not questioning your doctor's judgment; you are simply obtaining all the information you need to make an informed choice.

This includes understanding what you need to do to prepare for surgery (such as losing weight or stopping certain medications), how long it will take to recover from surgery, and what lifestyle changes you need to make after surgery to get the best results (such as changing your diet or quitting cigarettes). By fully understanding the risks and benefits of surgery, you can make better choices.

Frequently Asked Questions

What's the difference between an excision and a resection?

A resection means surgically removing an entire organ, a whole section of an organ (like an entire lung lobe), or a body part. An excision removes a portion of a body part or organ or a complete section of tissue. For example, a mastectomy is the resection of an entire breast, while a lumpectomy is the excision of a tumor from a breast.

How is excision surgery used to treat skin cancer?

Often, excision is the only treatment needed for basal cell or squamous cell skin cancers, as well as early-stage melanomas. In addition to the tumor, some healthy-looking tissue is removed and tested to ensure all the cancer is excised.

Can you have a tattoo cut out?

Yes, you can have a surgical excision to remove a tattoo. The skin with ink is cut out from the surrounding skin, and the wound is closed with sutures. The procedure requires local or, possibly, general anesthesia and usually leaves a surgical scar.