Dermatology clinic

Our surgeons can perform excision of lesions such as moles, cysts and lipomas (fatty lumps). Most are benign (non-cancerous) but some may be malignant or have the potential to become so. Excision refers to removal of a skin lesion by cutting it. Surgery is recommended to remove skin lesions that show any sign of turning cancerous or to diagnose the cause of the lesion. This is usually a quick and straightforward procedure.

Before the operation

Tell your surgeon if you are taking any medication, or if you have any allergies or medical conditions.

If you are taking aspirin your surgeon may ask you to stop it one week before surgery as it increases the risk of bleeding during and after the operation. The surgeon will advise you of this at clinic.

If you are on warfarin or any other blood thinning medicines (including clopidogrel), please make sure the surgeon knows when your minor operation is booked. The surgeon will then make a decision as to whether you should stop your medication.

On the day

You may eat and drink as normal.

If you smoke it is best to avoid smoking on the day of the operation and while the wound heals as smoking reduces blood flow to the skin as well as many other organs.

If you are on medication for high blood pressure or a heart complaint, take your medication as normal. If you are a diabetic, please bring your medication/insulin with you.

Please do not bring valuables with you. Feel free to bring a friend or family member.

We strive to run on time but sometimes delays occur. However, it is extremely unusual for a patient to have to wait for more than 30 minutes for a scheduled surgical appointment.

Sometimes patients are offered a same day surgical appointment when they are seen in clinic. If so, you will be informed of the waiting time for this and if inconvenient, you may return for another appointment.

When you are called into the theatre, the procedure will again be explained to you and you will be asked to sign a consent form if you have not already done so in clinic.

About the operation

The surgeon will inject local anaesthetic into the area surrounding the skin lesion to be treated (this causes a tingling/stinging sensation which will last only a few moments). This will numb the skin so no pain should be felt during the procedure. You may feel a pushing or pulling sensation as the lesion is removed, but this should not be painful. If you feel any pain, please inform the nurse/surgeon.

The most common type of excision is an elliptical excision. The ellipse is designed so that the resulting scar runs parallel with existing skin creases. This ensures that the scar is as narrow and short as possible. In some cases a margin of skin around the lesion may have to be removed, this will leave a bigger wound than you may expect from the size of the lesion.

There will be some bleeding in the area from where the lesion has been removed. The surgeon may coagulate the blood vessels with diathermy. This can make a hissing sound and a burning smell.

The wound will then be sewn together by bringing the wound edges directly together. The stitches will need to be removed in 5 to 14 days depending on the site of the lesion. If absorbable sutures are used these will disappear on their own.

After the operation

Post-operative pain is variable but often minimal. You may experience pain 1 to 2 hours after surgery when the anaesthetic wears off. Large wounds or those on areas subject to pressure (e.g. foot) or a lot of movement (e.g. shoulder) may be more uncomfortable. Painkillers such as paracetamol can be taken as required.

If a dressing is applied after surgery you will be advised if and when this should be changed.

Head and facial wounds are often left uncovered.

After-care advice

Keep the suture line clean and dry. You can wash around the area. A recent wound or one that has just had stitches removed should not be soaked in water.

Slight post-operative bleeding may stain the dressing. This is not unusual and requires no action. If however, persistent bleeding occurs, place another dressing on top of the original one and apply firm pressure without looking at it for 20 to 30 minutes. If it is still bleeding after this time, seek medical attention. Do not remove the original dressing.

Do not shave over the stitches if they are around the beard area.

You should not apply make-up to the operation site until healed.

Avoid clothing that is going to rub on the suture line.

If the suture line becomes red and inflamed, increasingly painful or any discharge occurs, please contact your GP. If the wound bleeds persistently or starts to come apart, please contact Clare House (stating you are a surgical patient), your GP or the out of hours service on 111.

Surgery around the eye or forehead can sometimes result in bruising (black eye). This requires no treatment and will disappear after approximately one week. To minimize the bruising place a few extra pillows under your head in bed at night.

Avoid damage to the wound. If the wound is in an area where it might be stretched, try to avoid strenuous exercise for approximately 2 to 3weeks after the operation. If head or neck lesion, avoid bending down and lifting weights, e.g. lifting children.

A couple of weeks after the stitches have been removed and any inflammation has subsided you will be advised to start massaging in some moisturising cream along the length of the scar line on facial wounds which will help with the final appearance of the scar. Do this twice a day for the next 12 to 24 weeks.  Avoid direct sunlight on the scar for at least six months after the surgery either by keeping it covered or by using high factor sunscreen.

Follow up

In general it is not necessary to review you in clinic routinely after these procedures. A letter about histology (type of lesion confirmation) will be sent to your GP and yourself.

Risks

Anyone having surgery needs to be aware of the possible complications.

Scarring

It is impossible to cut the skin without scarring in some way. In addition, scars in areas under tension may spread so that the resultant scar is wider than it was at the end of the operation. For the majority of people the scar will be red and raised for the first 3 months but usually reduces in colour over the first year.

Keloids or hypertrophic scarring

Some people have an abnormal response to skin healing and these people form scars that are red and raised.

Nerve damage

All surgery to the skin inevitably cuts small nerves. Occasionally, numbness or pins and needles around the wound may follow surgery and last for some weeks or occasionally months but recovery almost always occurs.

Infection

Signs of infection may include the wound becoming painful, red, swollen or inflamed, or an unpleasant smell or leakage of fluid from the wound.

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