In short. How a plastic surgeon assesses a skin lesion before removal: history, sun exposure, dermoscopy, ABCDE features, photography, review intervals, and when a biopsy or excision is needed rather than observation.
Key points
- Bring a list of your medicines, especially any blood thinner, your previous pathology reports if you have them, and dated photographs of the lesion if you have been tracking it.
- A clear timeline of when you first noticed it and what has changed since is often more useful than a single measurement.
Most skin lesions are harmless, and most people who ask about one leave the clinic reassured. The purpose of an assessment before excision is not to justify an operation but to decide whether an operation is needed at all, and if it is, what kind of specimen will give the clearest answer.
History comes before examination
The consultation begins with questions. How long has the lesion been there? Has it changed in size, colour or shape? Does it bleed, itch or hurt? Has it been treated or removed before? A lifetime of sun exposure matters, as does skin type and any tendency to burn rather than tan. A personal or family history of skin cancer lowers the threshold for action, and so does an earlier removal that showed something abnormal. These answers are not formalities. They shape how suspicious the lesion is before it is ever touched.
Examination, magnification and dermoscopy
The lesion is examined in good lighting, usually with magnification. Dermoscopy, a lighted magnifier that shows structures just below the surface, adds information the naked eye misses. It is an aid to judgement, not a diagnosis. The features often summarised as ABCDE — asymmetry, an irregular border, variation in colour, a diameter that is large or enlarging, and any evolution or change over time — are a prompt to sample the lesion, not a verdict on it. A lesion that is photographed and measured at each visit is easier to judge than one remembered vaguely.
What to bring to the consultation
Bring a list of your medicines, especially any blood thinner, your previous pathology reports if you have them, and dated photographs of the lesion if you have been tracking it. A clear timeline of when you first noticed it and what has changed since is often more useful than a single measurement.
When watching is the right answer
Many lesions need no surgery at all. A stable, uniform, long-standing spot in an adult can be reviewed rather than removed, particularly where excision would leave a conspicuous scar on the face or chest. Watching is an active decision with a plan attached: a photograph, a measurement, and a review interval agreed in advance, often three to twelve months depending on the features. If the lesion changes before the next appointment, the plan changes with it, so return sooner rather than wait.
When a tissue sample is needed
A lesion that is changing, bleeding, ulcerated, or clearly abnormal on dermoscopy should be sampled without a long delay. So should any lesion in a place you cannot easily monitor yourself. The choice between excision, shave biopsy and punch biopsy depends on what is suspected and where the lesion sits. Only a tissue sample examined under a microscope gives a diagnosis. No examination, however careful, can replace it.
Seek surgical review promptly if
- A lesion is growing, changing colour or shape, or looks different from your other moles.
- It bleeds, crusts, itches or hurts without a clear cause, or a sore fails to heal.
- You have had a skin cancer removed before, or there is a strong family history.
Frequently asked questions
What will be asked about a skin lesion before it is examined?
How long it has been there, whether it has changed in size, colour or shape, whether it bleeds, itches or hurts, and whether it has been treated or removed before. A lifetime of sun exposure, skin type, and any personal or family history of skin cancer all shape how suspicious it is.
When is watching a lesion the right answer?
A stable, uniform, long-standing spot in an adult can be reviewed rather than removed, particularly where excision would leave a conspicuous scar on the face or chest. Watching is an active plan: a photograph, a measurement, and a review interval agreed in advance, often three to twelve months.
Can dermoscopy diagnose a skin lesion on its own?
No. Dermoscopy adds information the naked eye misses, but it is an aid to judgement rather than a diagnosis. The features summarised as ABCDE are a prompt to sample a lesion, not a verdict on it, and only a tissue sample examined under a microscope gives a diagnosis.
Risks & Limitations
- Reconstruction is usually staged — more than one operation is normal, and the plan may change as healing progresses.
- Donor-site scarring and discomfort, including after rib cartilage harvest.
- Partial or complete failure of a flap or graft, which may require further surgery.
- Scars are permanent. They mature and fade but never disappear.
- Asymmetry and the inherent limits of matching a normal side.
- Altered sensation, numbness or weakness in the operated area.
- Contracture, which may need release procedures later.
- Final assessment is made at 6–12 months, and longer in growing children.
When to Seek Care
- A flap or graft that turns dark, cold, black or stops bleeding when pricked.
- Fever above 38 °C, or spreading redness, warmth or discharge around a wound.
- New or worsening pain, swelling or fluid leakage from the operative site.
- Bleeding that does not stop with gentle pressure.
- Any change in a reconstructed area that concerns you, however minor.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — reconstructive surgery guidance
- World Health Organization (WHO) — burn and trauma care resources
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
- Cochrane Library — systematic reviews in wound and reconstructive care
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.