The palpable lesion is fixed between two fingers. Local anesthesia (mixture of short and long acting, e.g. .5% lidocaine, .25% marcaine) is slowly injected along the line of incision to raise a 4-5 mm dermal wheal. A one cc syringe is most effective for injecting because the force per unit area of the small plunger makes injection easy and controllable. Excessive skin injection is avoided to preserve feel of the lesion.