Learn More About Excision versus ED&C
Each procedure has pros and cons and you have to decide what is best for your comfort in recurrence rate, cosmetic outcome, and lifestyle.
An excision has a slightly better cure rate than a destruction by a few percentage points. So the skin cancer has a slightly lower chance of coming back in that same spot. Also, the removed tissue is sent to the lab for analysis. The pathologist will look at the margins to be sure the cancer is removed. There is no such analysis for a destruction.
The excision also generally heals faster than a destruction. Depending on the site, stitches are removed in two weeks or less. A destruction generally takes four or more weeks to heal. If located on the lower leg, it can be 6 weeks or longer.
The excision generally heals with a thin line-type of scar. A destruction heals with a pink round scar that fades to white over time. Most patients (and the doctors) feel an excision has a superior cosmetic outcome over a destruction.
A destruction allows the patient to get back to non-aquatic (non-water) sports sooner, usually a day or so later. This is because activities like golf, tennis, pickleball, weight lifting, and even fishing can put too much stress on stitches and risk opening up the wound. These activities should wait until after the stitches are removed.
For those who enjoy water sports or lounging in the pool, wounds generally heal more quickly after an excision, so that may be a better choice.
Each patient has to decide what they think is best and what their priorities are.
If left to the doctor, he feels the excision is preferable, due to the slightly lower recurrence rate and faster, better healing, along with a better long-term cosmetic result.
Patients may ask why they were not offered Mohs surgery for this spot as a treatment option. For the size of the spot they have, and the location they have it, Mohs surgery would not be covered by their insurance carrier. We have to follow Appropriate Use Criteria for Mohs Surgery established by the American Academy of Dermatology and the American College of Mohs Surgery.
They can still choose Mohs Surgery, but it would not be an insurance-covered option, and they would have to pay out-of-pocket for this treatment. If they are still interested in having that as treatment, they should call the office for more information.