CPT® Code 11646

The CPT® Code 11646 refers to the excision of a malignant lesion located on the face, ears, eyelids, nose, lips, or mucous membrane, where the excised diameter exceeds 4.0 cm. This procedure involves the surgical removal of a cancerous growth along with a margin of surrounding healthy tissue to ensure complete excision of the malignancy. Common types of malignant lesions that may be excised using this code include basal cell carcinoma, squamous cell carcinoma, verrucous carcinoma, and melanoma. The process begins with the cleansing of the affected area, followed by the administration of a local anesthetic to minimize discomfort during the procedure. A careful identification of a healthy tissue margin is crucial, as it helps in determining the extent of the incision needed. A full-thickness incision is then made through the dermis, encircling the lesion to facilitate its complete removal. In some cases, a frozen section may be performed during the excision to verify that the margins are free of malignant cells. If any cancerous tissue is detected at the margins, additional tissue will be excised until clear margins are achieved. The excised lesion is subsequently sent for histologic evaluation to confirm the diagnosis and assess the margins. To manage any bleeding that may occur during the procedure, electrocautery or chemical cautery techniques are employed. Finally, the surgical wound may be closed using a simple single-layer suture technique, although more complex closure methods such as intermediate (layer) closure, complex repair, skin grafts, or pedicle flaps may also be utilized depending on the specific circumstances of the excision.