What are the techniques for removing a suspicious lesion from the face?

From the Guidelines

Suspicious lesions on the face should be removed through excisional biopsy with a narrow peripheral margin of 1 to 3 mm around the concerning skin lesion, as recommended by the most recent guidelines 1. When it comes to removing suspicious lesions from the face, the goal is to balance diagnostic accuracy with cosmetic and functional outcomes. The choice of technique depends on the lesion's characteristics, size, and location.

• Excisional biopsy is the preferred method for removing suspicious lesions on the face, as it allows for the removal of the entire lesion with a margin of normal skin, which is essential for accurate diagnosis and staging.
• Elliptical excision, punch excision, and deep shave/saucerization are all acceptable methods for excisional biopsy, as long as they are performed with a narrow peripheral margin of 1 to 3 mm around the concerning skin lesion.
• Incisional or punch biopsy may be considered for lesions in sensitive areas or for very large lesions, but excisional biopsy is generally preferred.
• Other options, such as shave excision, curettage and electrodesiccation, cryotherapy, and laser therapy, may be considered for certain types of lesions or in specific clinical situations, but excisional biopsy remains the gold standard for diagnostic accuracy and staging. The most recent guidelines from the Journal of the American Academy of Dermatology 1 emphasize the importance of excisional biopsy with a narrow peripheral margin for the diagnosis and staging of primary cutaneous melanoma.
• Prebiopsy photographs and dermoscopy can aid in diagnostic accuracy and help direct optimal tissue sampling.
• Newer noninvasive techniques, such as reflectance confocal microscopy and gene expression analysis, may also be considered as adjuncts to histopathologic assessment. It's essential to have suspicious lesions evaluated by a dermatologist or facial plastic surgeon who can determine the appropriate removal technique based on the lesion's appearance, size, location, and suspected diagnosis, as well as provide guidance on post-procedure care and follow-up.

From the Research

Suspicious Lesion Removal Techniques

• The decision to remove a suspicious lesion from the face should be based on a thorough evaluation of the lesion, including its appearance, size, and location 2.
• Various biopsy techniques can be used to remove suspicious lesions, including shave, saucerization, punch, fusiform, and subcutaneous nodule biopsies 2.
• The choice of biopsy technique depends on the type and location of the lesion, as well as the patient's overall health and medical history.

Anesthesia and Analgesia for Lesion Removal

• Topical anesthetics, such as eutectic lidocaine/prilocaine 5% cream, can provide effective analgesia for minor cutaneous surgical procedures, including excisional biopsy or curettage with electrosurgery 3.
• The use of topical anesthetics can reduce the need for needle puncture and infiltrational anesthesia, which can be associated with anxiety, fear, discomfort, and pain 3.
• The effectiveness of anesthesia and analgesia techniques during surgery may also have an impact on long-term oncologic outcomes, although more research is needed to fully understand this relationship 4.

Considerations for Facial Lesion Removal

• When removing a suspicious lesion from the face, it is important to consider the potential impact on the patient's appearance and quality of life 2.
• Clinicians should strive to provide a cosmetically acceptable result from the procedure, while also ensuring that the lesion is fully removed and that the patient receives adequate anesthesia and analgesia 2, 3.