An incision along the skin's tension lines, closed with fine sutures, with the specimen sent to the pathology lab.
Elliptical excision along natural tension lines, closed with fine sutures. Scar as discreet as possible.
Every excised specimen is sent for histological analysis. It is the only modality (along with Mohs) that confirms the exact nature of the lesion.
Incision follows tension lines. Two-layer closure distributes tension. Scar matures at 1 year, usually discreet.
Five periocular conditions that Dr. Dzolang treats with excision after confirming the lesion is benign and not requiring referral.
Large or atypical mole on the eyelid that changes in appearance or requires pathological analysis.
Large or recurrent xanthelasma that cannot be fully removed with other techniques (laser, plasma).
Epidermoid or sebaceous cyst on the eyelid that reoccurs if the capsule is not completely removed.
Very thick or recurrent seborrheic keratosis after initial treatment with cryotherapy or plasma.
Large pedunculated skin tag (acrochordon) that rubs or bleeds, and for which removal with sutures offers a cleaner result than cryotherapy alone.
Three situations where excision is referred elsewhere, and three situations where waiting or an alternative approach is preferred.
Lesion on the free eyelid margin, near the lacrimal punctum or tear ducts — mandatory referral to oculoplastics.
Suspected skin cancer (carcinoma, melanoma) on the eyelid — referral to dermatology or Mohs surgery before any removal.
Active skin infection at the excision site — such as cellulitis, stye, or open wound.
Anticoagulant medication use or uncontrolled bleeding disorder — higher risk of bleeding or hematoma.
Keloid or known hypertrophic scarring tendency.
A visit lasting about 30 to 45 minutes, with a follow-up appointment for suture removal in 5 to 7 days.
Lesion examination, marking before infiltration, local lidocaine injection. Numbing in a few minutes.
Elliptical excision along natural tension lines. Specimen sent for pathological analysis. Closure with fine 6-0 or 7-0 sutures.
Dressing, antibiotic ointment 5-7 days, SPF 50+ 6 months. Suture removal at 5-7 days on eyelid. Pathology analysis result provided at removal visit.
THE CARE EXPERIENCE
Family Physician Trained at the Université de Montréal and a current member in good standing of the Collège des médecins du Québec (CMQ), Dr. Karen Dzolang serves as the medical director of the CARE network. For eyelid lesions like xanthelasma, she helps frame the assessment, possible indications, limits of removal, and situations where another medical opinion might be preferable.
