The greater majority of skin cancers tumours can be removed with a margin of normal tissue and the wound closed at the time of surgery. The tumour is then sent to the laboratory where it is examined by a pathologist (a doctor who specialises in looking at such samples under microscope). A report is submitted identifying the tumour and its characteristics and completeness of its removal.
However there are cases where the treating doctor would like to know before closing a wound whether the tumour has been completely removed, and this is where the Staged Excision plays a role. In Staged Excision the tumour is removed and sent to pathology for priority reporting. The wound is not stitched at this stage, but a special dressing is applied and the patient can go home. The patient returns the next day and the report is available indicating the adequacy of tumour removal. If the margins of healthy tissue around the tumour are within required limits then the wound will be stitched. If more tissue needs to be removed this can be performed and sent for further reporting with the patient returning again the next day. This process can be repeated for up to one week until the tumour is confirmed to be completely removed.
However, if additional excision is needed, most excisions need to be further excised only once as the Pathology report indicates the depth and width required.
Staged Excision has certain indications and these may include:
- Tumour with poorly defined margins.
- Previous incompletely excised tumours.
- Recurrent tumours.
- In situations where a complicated repair is required to close the wound such as a large flap or skin graft.