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A wide local excision is the definitive surgery for melanoma and for high-risk or atypical lesions. After the biopsy has confirmed the diagnosis and measured its depth, the site is re-excised with a margin of normal skin measured in centimetres rather than millimetres, and the specimen is examined to confirm the margins are clear. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, plans the margin from the pathology report and performs the procedure himself. Covered by Alberta Health Care with a referral.
Melanoma is excised twice: a biopsy to make the diagnosis and measure how deep it goes, then a wide local excision whose margin is set by that depth.
Wide local excision is specific to melanoma and to lesions whose behaviour is uncertain. Other cancers and other situations call for other procedures.
Basal cell and squamous cell carcinomas are excised with a margin of a few millimetres. A wide excision is not needed and would cost skin for no gain.
Cancer excisionsFor lentigo maligna on the face, where a centimetre of skin is precious, margins can be checked under the microscope during surgery. Referred to a Mohs surgeon.
Melanomas above a certain depth are staged by sampling the draining lymph node at the same time as the wide excision. Referred to a surgical oncologist, usually with the wide excision done there too.
A severely atypical mole with an involved biopsy margin is re-excised with a small margin to prevent recurrence and remove any doubt.
Freckles and molesA wide local excision is only as good as the reading of the pathology that precedes it and the staging decision that follows it.
Every wide local excision follows a biopsy. Nothing is widely excised on appearance alone.
Confined to the surface. Half-centimetre margins. Cure is expected once the margins are clear.
One-centimetre margins in the clinic. Excellent prognosis with follow-up.
Skin cancerWider margins and sentinel node staging, usually with surgical oncology. Dr. Kuzel coordinates the referral.
Re-excised with a small margin when the biopsy margin is involved or the pathology is ambiguous.
Freckles and molesMerkel cell carcinoma, dermatofibrosarcoma and other rare tumours are excised widely or referred, depending on the diagnosis.
The examination and biopsy that find a melanoma early, when a wide excision is all that is needed.
Skin checksThe wide excision is booked within weeks of the biopsy result, and takes forty-five to ninety minutes.
A wide excision is under more tension than a standard one. Protecting it from stretch for the first weeks is what keeps the scar narrow.
Melanoma diagnosis, wide local excision, pathology and follow-up are covered by Alberta Health Care with a referral from your family physician. No fee is charged.
Referrals by fax to (403) 225-2914. Call (403) 286-6888 with questions.
The scar is longer than most patients expect, because a wide margin needs a long ellipse to close flat: commonly five to ten centimetres. It is pink and firm for three months and pale by a year. Scars on the back and shins are the widest.
Clear margins on the wide excision specimen complete the local treatment. For in-situ and thin melanoma, the outlook after clear margins is excellent. For thicker tumours the wide excision is one part of a plan that includes staging and, where needed, further treatment with oncology.
Follow-up is lifelong. Full skin examinations find a second melanoma, which is more likely once you have had one, and lymph node examinations find recurrence early. Daily sun protection is part of the treatment.
The biopsy makes the diagnosis and measures the depth. The wide excision removes the margin of skin that depth requires. The two cannot be combined because the margin is not known until the biopsy is read.
Yes. Diagnosis, wide local excision, pathology and follow-up are covered by Alberta Health Care with a referral.
Commonly five to ten centimetres, because a wide margin needs a long ellipse to close flat. It fades to a pale line over a year.
The anaesthetic injection stings briefly; the excision is painless. The site is sore and tight for several days afterward, and simple analgesics are enough.
Sampling of the first lymph node that drains the melanoma, to see whether it has spread. It is recommended above a certain depth and is done by a surgical oncologist, usually at the same time as the wide excision.
A further excision is performed. This is uncommon; the margin is set to avoid it.
Desk work within a day or two. Physical work three to four weeks, longer for the back and legs, because stretching the wound widens the scar.
Usually yes. Stopping them risks a stroke or clot; extra bleeding is managed at the time. Tell Dr. Kuzel everything you take.
By stage: every three to six months for the first years, then yearly, with full skin and lymph node examination each time.
Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South, plans and performs every wide local excision personally and follows every melanoma patient. He sees patients in English and Czech.
Grouped by what you are trying to find out.
Ask your family physician for a referral, or book a consultation directly. Melanoma referrals are seen promptly.
Rejuvenation Dermatology Calgary South
10201 Southport Rd SW #102
Calgary, AB T2W 4X9
Two blocks west of the Delta Hotel
(403) 286-6888
Referrals by fax: (403) 225-2914
Open seven days a week, with early mornings and evenings on weekdays.
Take the first step toward achieving healthy, radiant, and flawless skin. Contact Rejuvenation Medical Aesthetics today to schedule your personalized consultation and explore the advanced treatments tailored to your unique needs.
