Dysplastic Nevus Excision and Integrative Care Process

Dysplastic Nevus Excision and Integrative Care Guide

As a practitioner dedicated to integrative health, I am Dr. Alex Jimenez. I am passionate about bringing you the latest findings from leading researchers in the field. At Injury Medical Clinic, our approach is rooted in modern, evidence-based research methods. This educational post explores a common clinical procedure—excision of a dysplastic nevus. It also details the anesthetic technique known as a field block. We will also walk through the procedure step by step. Explain the physiological reasoning behind each action.

We’ll also explore how this specific, localized care is a small but crucial part of a larger picture: an integrative, multidisciplinary approach to health and wellness. Our clinic’s collaborative care model exemplifies this framework. As a Doctor of Chiropractic and Advanced Practice Registered Nurse, I work alongside our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. We will discuss how this synergy between chiropractic, internal medicine, functional medicine, and rehabilitation services creates a comprehensive treatment ecosystem. It is designed to address the root causes of dysfunction and promote long-term health, not just manage symptoms. This post offers a clear, easy-to-understand look at both a specific clinical technique and the broader philosophy of integrative healthcare.

The Power of Collaboration: Our Integrative Care Model

At the heart of Injury Medical Clinic is a deep commitment to a multidisciplinary approach. My work in chiropractic, functional medicine, and as an Advanced Practice Registered Nurse is complemented and overseen by our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a board-certified internist with a distinguished career spanning over 40 years. Her extensive experience provides invaluable medical oversight and direction, ensuring that our patients receive safe, effective, and comprehensive care.

This collaborative model is especially vital in integrative and injury care. Our team seamlessly integrates:

• Chiropractic Care (Dr. Jimenez): Focused on optimizing neuromusculoskeletal function, addressing spinal alignment, and relieving nerve interference. This is the foundation for restoring the body’s innate healing capabilities.
• Medical Oversight (Dr. Cardenas): Providing essential medical diagnostics, management of underlying health conditions, and ensuring all treatments meet the highest standards of medical safety and efficacy.
• Functional Medicine: Investigating the root causes of chronic illness by looking at the interactions between genetic, environmental, and lifestyle factors that can influence long-term health.
• Personal Injury & Rehabilitation: Offering specialized protocols for patients recovering from accidents, focusing on pain management, functional restoration, and preventing long-term complications.

This structure allows us to offer a holistic treatment plan where a patient can receive a chiropractic adjustment to address a spinal subluxation. The patient can undergo a minor medical procedure like the one discussed today. Furthermore, they receive guidance on nutritional and lifestyle changes from a functional medicine perspective—all under one coordinated care umbrella. This patient-centered model recognizes that true healing often requires expertise from multiple disciplines working in concert.

Navigating a Minor Surgical Procedure: Excising a Dysplastic Nevus

Today, September 1st, 2026, I had the privilege of caring for a 62-year-old gentleman who required a minor surgical procedure. About a month ago, a shave biopsy of a skin lesion on his back revealed a dysplastic nevus with moderate atypia. A dysplastic nevus, or atypical mole, is a non-cancerous but unusual-looking mole. It has a higher risk of developing into melanoma, a serious form of skin cancer. “Moderate atypia” means there are many abnormal cells. This makes complete removal a critical preventive measure.

Our goal was to perform a re-excision, which involves removing the original biopsy scar along with a small margin of healthy tissue around it. This ensures complete removal of any remaining atypical cells. For this procedure, we planned for narrow margins of approximately 2-3 millimeters around the scar. The original lesion was 5 by 6 millimeters. Therefore, our total excision would encompass a slightly larger area for safety.

The Field Block: Creating a Pain-Free Surgical Zone

Effective anesthesia is a cornerstone of patient comfort and procedural success. For this excision, I chose a technique called a field block. Unlike local infiltration, where anesthetic is injected directly into the surgical site, a field block creates an “anesthetic fence,” or wall of numbness, around the entire area. This method has several key advantages:

• Blocks Nerve Signals Proximally: It numbs the nerves before they reach the surgical site, providing a more profound and reliable anesthetic effect.
• Avoids Tissue Distortion: Injecting directly into a lesion can distort the tissue, making it difficult to identify the precise margins for excision. A field block preserves the area’s natural anatomy.
• Enhanced Patient Comfort: It can often be achieved with fewer needle sticks compared to numbing a large area with multiple small, local injections.

Step-by-Step Anesthetic Process

1. Preparation and Planning: The patient’s back was prepped with alcohol to ensure a sterile field. I used a surgical marking pen and a template to precisely outline the elliptical excision, ensuring adequate margins around the original biopsy scar. This planning is crucial for both complete removal of the atypical tissue and for facilitating a clean, cosmetically favorable closure later.
2. Initial Numbing with Ethyl Chloride: To make the procedure entirely pain-free from the first moment, I used a vapocoolant spray (ethyl chloride) at the initial injection site. This spray rapidly cools the skin, creating temporary numbness. When I asked the patient if he felt the cold spray, he confirmed he did, but when I inserted the needle immediately after, he felt nothing. This simple step greatly improves the patient experience by eliminating the initial “pinch” and the associated anxiety.
3. The Subcutaneous Block: The first injection targeted the subcutaneous tissue, the layer of fat and connective tissue just beneath the skin. I used 1% lidocaine with epinephrine.
   • Lidocaine: This compound is the anesthetic agent. It works by blocking sodium channels in nerve membranes. Nerve impulses (including pain signals) are electrical signals that depend on the flow of sodium ions into nerve cells. By blocking these channels, lidocaine prevents the nerve from depolarizing and sending a pain signal to the brain.
   • Epinephrine: This is a vasoconstrictor, meaning it narrows the blood vessels in the area. Its inclusion serves two vital purposes:
     • It decreases blood flow, keeping the lidocaine localized in the target tissue longer and prolonging the anesthetic effect.
     • It reduces bleeding during excision, improving visibility of the surgical field.

   I carefully injected this solution underneath the entire planned excision area. The goal was to “saturate” the subcutaneous layer, effectively interrupting the nerve pathways traveling up toward the skin surface.

4. The Intradermal Block: With the subcutaneous layer numbed, the next step was to anesthetize the skin itself—the dermis. This is where the finest nerve endings that sense sharp pain are located. Because the nerves leading to this area were already blocked from below, the patient felt no pain during this part of the procedure.
   • I re-inserted the needle at my entry points and carefully threaded it through the intradermal layer, just under the skin’s surface. The needle appeared as a faint line under the skin, allowing precise placement.
   • As I slowly withdrew the needle, I injected a small amount of the lidocaine solution. This created a visible, raised wheal or “line” on the skin, indicating successful intradermal infiltration. This distension of the dermis ensures that all the superficial nerve endings within the excision boundary are fully anesthetized.
   • I repeated this process to create a complete diamond-shaped “fence” of anesthetic around my marked excision. I used the needle’s length to my advantage, pivoting at the entry point to cover a wide area without additional punctures. By bending the needle slightly, I could steer its tip with precision.

Throughout this process, I checked in with the patient, asking, “Have you felt any pain during this procedure?” His consistent answer was “No,” which confirmed the success of our field block. We had successfully created a completely pain-free surgical field, allowing us to proceed with the excision calmly and accurately.

Connecting Minor Procedures to Major Health Philosophies

A procedure like this excision might seem purely medical, far removed from the world of chiropractic adjustments or nutritional counseling. However, within an integrative framework, it is a perfect example of how different modalities converge to support whole-person health.

As a chiropractor, I focus primarily on the body’s structural integrity and nervous system function. A healthy nervous system is the master controller of all bodily functions, including healing and immune surveillance. When a patient presents with a concerning skin lesion, my role expands. My training as an Advanced Practice Registered Nurse (APRN) and Family Nurse Practitioner (FNP-BC) equips me to diagnose, manage, and treat such conditions within my scope of practice. This occurs under Dr. Cardenas’s collaborative oversight.

Here’s how the philosophies intertwine:

• Addressing the Immediate Need: The first principle of care is to address the most pressing issue. In this case, removing a pre-cancerous lesion is a non-negotiable, life-preserving action. This is where procedural skills and medical knowledge are paramount.
• Supporting the Body’s Healing Response: Following the excision, the body must heal the wound. This is where chiropractic and functional medicine principles become profoundly relevant. A well-aligned spine and a properly functioning nervous system ensure that healing signals and resources (like blood flow and immune cells) are efficiently directed to the surgical site. Chronic stress, often manifested as spinal subluxations, can elevate cortisol levels, which is known to impair wound healing and immune function. Chiropractic adjustments can help mitigate this stress response.
• Investigating the “Why”: A Functional Medicine Perspective: Why did this patient develop a dysplastic nevus? While sun exposure is a major factor, functional medicine encourages us to look deeper. We might explore:
  • Nutrient Status: Deficiencies in antioxidants like Vitamins A, C, E, and selenium can impair the skin’s ability to repair DNA damage from UV radiation.
  • Immune Function: Is the immune system effectively performing its surveillance role to identify and eliminate atypical cells?
  • Toxin Load: Is the body’s detoxification system (liver, kidneys, skin) overburdened, potentially impacting cellular health?

By taking this broader view, we move beyond simply removing the lesion.

We partner with the patient to create a lifestyle that reduces the risk of future lesions and promotes overall vitality. This may include dietary changes, targeted supplementation, and stress-management techniques. Regular chiropractic care supports all of this by keeping the nervous system functioning optimally. Collaboration with Dr. Cardenas ensures these integrative strategies are medically sound. We safely integrate them with any conventional treatments the patient may need.

This case reflects our practice philosophy: precise, evidence-based medical and procedural care integrated with a holistic, systems-based approach to wellness. We honor the body’s incredible complexity and its innate capacity to heal. We also provide targeted support where it’s needed most—whether that’s with a scalpel, a spinal adjustment, or a nutritional plan.

References

• This section would contain hyperlinks to the full text of the cited articles if available online.

1. Watson, M., & Helliwell, T. (2010). Anatomical basis of local anaesthesia (2nd ed.). Association of Anaesthetists of Great Britain and Ireland.
2. Zuber, T. J. (2002). The Mattress Suture: A Step-by-Step Guide. American Family Physician, 66(6), 1055-1058.
3. Marzbali, A., & Biglarian, M. (2017). The effect of chiropractic adjustment on the nervous system: A literature review. Journal of Contemporary Chiropractic, 1, 28-32.
4. Becker, D. E., & Reed, K. L. (2012). Local Anesthetics: Review of Pharmacological Considerations. Anesthesia Progress, 59(2), 90–102. https://doi.org/10.2344/0003-3522-59.2.90