Surgical removal: Can be effective for small lesions in safe areas but carries a relatively high failure rate. Special surgical precautions can be taken to reduce (but not eliminate) the risk of recurrence.
Nodular lesions in the groin and thigh areas are sometimes amenable to this method provided that the lesions have no skin involvement.
Nodules round the eye should not be treated surgically without careful consideration.
Laser surgery may be effective in some cases but it is not simple to perform and is not widely available.
Surgical treatment followed by other methods is reported to have a correspondingly higher rate of success.
In general there is a feeling that surgery is better if the wound site is not sutured afterwards although the open site could be a source of reintroduction of sarcoids and is of course both slow to heal and in some sites highly problematic. Infection is a potential problem also.
The best prognosis is achieved by selection of the most amenable lesions (i.e. small, very well defined, localised lesions in convenient sites) for surgical removal.
The prognosis for surgical removal can be improved by scrupulous use of a protective method that precludes the contact of the surgical site with desquamated cells from the active sarcoid lesion. This can be done with plasticised dressings or simply with surgical dressings placed over the lesion before surgery commences.
A ‘one-cut, one-blade’ principle where no instrument is returned to the surgical site following a single use also helps.
Laser surgery being used to excise a complicated Type A nodular sarcoid (invasive form) in the medial stifle region of a 9 year old showjumping mare. The resulting wounds were sutured and healed well without complication. However, there were several other very small ill-defined areas that required a later surgery.