Recipient(s) will receive an email with a link to 'Fusiform Excision' and will have access to the topic for 7 days.
Subject: Fusiform Excision
(Optional message may have a maximum of 1000 characters.)
The recommended surgical tray for office surgery is listed in Appendix G. Suggested suture removal times are listed in Appendix J.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Skin preparation accommodations appear in Appendix E.
Removal of pigmented melanocytic nevi to identify melanoma and ascertain the depth of the lesion
Small tumors or skin cancers that can be removed with fusiform excision
Incisional biopsy of a large lesion when excision is not feasible
Flat lesions not readily amenable to shave excision
Lesions on convex surfaces that are not amenable to shave excision
Removal of subcutaneous tumors
Severe bleeding disorders
Extreme illness that would make wound healing difficult
Cellulitis in the tissues to be incised
Conditions that may interfere with wound healing (collagen vascular diseases, smoking, diabetes)
Concurrent medications that may increase the likelihood of intraoperative bleeding (aspirin, other nonsteroidal anti-inflammatory drugs, warfarin)
PITFALL: Many experienced physicians perform fusiform excision without drawing out the skin incision lines. After the sterile drapes are placed on the skin, the nearby landmarks may be covered, causing the physician to incorrectly orient the excision.
PITFALL: Some providers want to save as much tissue as possible and draw the fusiform excision with kthe length only two times the width. These so-called football excisions create elevations of tissue at the ends (i.e., dog ears). The attempt to excise less tissue often produces inferior cosmetic results.
PEARL: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PITFALL: Many inexperienced operators make a short pass with the scalpel, stop to inspect the incision, and then make an additional short pass. This creates crosshatch marks and an irregular skin edge. Smooth, confident passes with the scalpel avoid jagged edges.
PITFALL: Create the incision with the blade vertical to the skin surface. Novice surgeons often angle the blade under the lesion, creating a wedge excision. Angled edges will not evert well.
PITFALL: Elevating skin edges using skin hooks prevents the damage and subsequent scarring that often result from handling the edges with forceps.
PEARL: A cheap, disposable skin hook can be created by bending the tip of a 1-inch, 20-gauge needle with the needle driver.
PEARL: Using retractors, or using pickups as a retractor, eliminates damage to the skin edge.
PITFALL: Inexperienced providers frequently are distracted by the minor bleeding (especially from facial wounds) produced by undermining. The closure of the deeper tissues using deep, buried sutures almost always stops the bleeding. Physicians should move quickly to perform the deep buried closure, rather than waste time applying gauze to the wound.
Pain, infection, and bleeding
Nonunion of skin edges
Incomplete excision of lesion
CPT is a registered trademark of the American Medical Association.
2008 average 50th Percentile Fees are provided courtesy of 2008 MMH-SI’s copyrighted Physicians’ Fees and Coding Guide.
TAL, trunk, arms, or legs; SNHFG, scalp, neck, hands, feet, or genitalia;
FEENLMM, face, ears, eyelids, nose, lips, and mucous membranes.