Serial Excision – Removing Large Skin Lesions

When it comes to removing large skin lesions—whether they’re moles you were born with (congenital) or ones that have developed over time—things aren’t always straightforward. Sometimes, a single procedure isn’t the best or safest option. In these situations, Specialist Plastic Surgeons, such as Dr Safvat, often use specialised techniques to achieve the best result, both medically and cosmetically.

Two common approaches are tissue expansion and serial excision.

What Is Tissue Expansion?

This method is often used for very large lesions, particularly in children. A small balloon-like device called a tissue expander is placed under the skin near the lesion. Over several weeks or months, saline (sterile salt water) is injected into the expander through a small port to slowly stretch the surrounding skin. Once there is enough extra skin, the lesion can be removed, and the stretched skin is used to close the area. This method can be quite effective but requires a strong commitment from the patient and their family, as it involves multiple visits and careful follow-up.

What Is Serial Excision?

Serial excision is a simpler, staged approach. It involves gradually removing a large lesion in two or more minor procedures, allowing the surrounding skin time to stretch between each stage.

For example, a young man recently came to see Dr Safvat with a large birthmark (mole) on his nose. It was too big to remove all at once without leaving a noticeable scar. Instead of doing a graft or flap (which might not have looked as natural), Dr Safvat suggested serial excision as the best form of treatment. The patient was happy to go ahead with Dr Safvat’s advice, even though he would have preferred a faster option.

In the first procedure, Dr Safvat removed part of the lesion without making the scar wider than necessary. After a few months—giving the skin time to adjust—he did a second procedure to remove the rest. The end result was a neat, linear scar that blended well with the natural contours of his nose. The patient was very happy with the final outcome.

Why Patience Pays Off

Understandably, most people hope for a quick, one-time solution. But in some cases, taking a slower, staged approach leads to a much better cosmetic result—and a more satisfying outcome in the long run. As surgeons, part of our role is helping patients understand these options and guiding them toward the choice that will give them the best result, even if it takes a bit longer.