Excision.
A:The incision is started using the point of the scalpel, held in a vertical position, at the apex of the lesion. Traction is accomplished with the nondominant hand.
B:The tissue is dissected free of the underlying fat. Forceps are used to hold the apex of the skin being removed.
C:Undermining is performed using blunt-tipped scissors while the skin edge is elevated by forceps.
D:Hemostasis is achieved with an electrocautery device.
E:Deeper, nonabsorbable sutures are used to approximate the wound edges.