What Is a Wide Local Excision?

A wide local excision is a surgery that is performed to remove unhealthy or abnormal tissue. Often, along with the unhealthy tissue, a rim of healthy tissue around along its marginal areas is also removed. Such excisions are part of surgical procedures that are commonly performed to check for and remove cancerous growths. Tissue obtained during such medical procedures is sent for pathological diagnosis to verify whether it is malignant or benign.

Also called a biopsy, a wide local excision's size is limited to about 4 cm in maximum diameter. Generally, tissue is removed to a depth of ½ to 1 inch (1.27 to 2.54 cm). For this reason, it is known as conservative surgery, involving a specific, localized area of the body. Anesthesia commonly consists of local anesthetic rather than the general anesthesia required for most operations. Following the excision, small sutures are placed to bring the skin back together during healing, usually leaving at most a tiny scar.

Tissue from a wide local excision is checked carefully in the laboratory under a microscope to make certain that all of the unhealthy tissue was removed. A diagnosis is made by a pathologist, a medical doctor who specializes in studying types of tissue and determining whether it is healthy or unhealthy. The pathologist checks to see if all the margins of the unhealthy tissue can be seen, and if these are not evident, the pathologist suggests that another excision may be necessary. The results given by a pathologist help the doctor decide what type of treatment to consider for the patient.

There can be many reasons for making a wide local excision. For example, a dermatologist — a doctor specializing in skin disease — may use the technique for a cyst removal. The cyst can then be studied to determine whether or not it is a type of skin cancer called melanoma. A wide local excision involves the surgical removal of the primary melanoma tumor along with a rim of surrounding normal skin. Rarely, a skin graft is necessary to fill in the space.

A gynecologist — a doctor specializing in women’s health care — may refer a patient to a general surgeon to make a wide local excision of breast tissue or of the lymph nodes. This procedure is to check for breast cancer. Depending upon the pathological diagnosis, a further surgical procedure called a lumpectomy may be needed, which removes an even larger portion of tissue.