You can download a printable PDF version of this information from the link below.

Before you have the procedure performed you will be asked to sign a consent form and it is important that you understand the risks and benefits of the procedure before you give your consent to skin surgery. The aim of this leaflet is to provide you with as much information as possible to help you with giving your consent. We have also tried to include responses to frequently asked questions about skin surgery. Any alternatives to surgery should have been discussed with you by your doctor before the appointment for skin surgery is booked.

If, after reading the information, you have any concerns or queries please discuss them with us, either by speaking to one of the members of the dermatology team whilst you are waiting for same day surgery, or by contacting us if you have been booked to come back another day for your surgery. Contact numbers for each hospital are on the front page of this leaflet.

Once you have had your procedure, further information will be provided about post-operative care, how to look after your wound and what to do if you have problems.

What to expect

 What will happen when I have the skin surgery?

Local anaesthetic:

• The procedure will be performed using a local anaesthetic which will numb the area and stop you from feeling pain. You will not be put to sleep.
• The surgeon will inject a small amount of liquid (local anaesthetic) into the skin area being treated. This may be uncomfortable (feel like a bee sting) for about 10 seconds.
• Your doctor will check the area before starting the surgery. Once the area is numb you should not be able to feel pain, you may still be aware of a sensation of pressure.
• The numbness may remain for about 2 hours.
• You may eat, drink and take your medications as normal before and after your procedure. The only thing to be aware of is that local anaesthetic injected near the mouth can make your lips numb so you will need to be careful of hot drinks or biting your lip until the feeling returns.

The procedure itself:

There are several different procedures that the skin surgeon may perform and you should understand the type of procedure that you will be having. It is circled below for you:

• Curettage & cautery – curettage means the lesion will be scooped or scraped off the surface of the skin without involving deep tissues. The raw area is then cauterised with an electric current that seals the blood vessels to stop the bleeding.  No stitches are used and the area will heal like a burn.
• Excision – this means the lesion will be removed by cutting it out. Your scar may be up to three times the size of the original lesion.  This ensures the entire lesion is removed and the wound edges can be brought together without them being under too much tension.  Stitches are used to close the wound.
• Biopsy (incisional or punch) – means that only part of the lesion will be removed. Stiches are usually used to close the wound. This procedure is normally performed if there is uncertainty about the diagnosis of your rash or skin lesion.  Further treatment may be required depending on the results.

What are the benefits of skin surgery?

There are usually two main benefits of skin surgery:

• A skin sample will be sent to the laboratory for microscopic analysis to confirm or help with the diagnosis of your skin lesion or skin rash
• If you are having a ‘mole’ or other skin lesion removed completely then the procedure is often for treatment as well as diagnosis

What are the risks of skin surgery?

Scarring:

• All surgery involving cutting the skin will leave a scar and the likely scar will depend on the procedure (see above); most scars usually flatten and fade over time.
• Scars often heal well but sometimes the scar can become paler or darker than the surrounding skin.
• There is a possibility that the scar can become raised and thickened.
• Scars might become sore or itchy due to the nerves healing.
• A keloid scar is an abnormal thickened scar, only a small number of people develop these scars and they tend to run in families; please let us know if you may be at risk of a keloid scar.

Pain or discomfort: You may have pain after your procedure, it is usually relatively mild.  Paracetamol is preferred as pain relief.  More severe pain may indicate infection of your wound especially if this occurs after two days.

Swelling: There may be swelling initially after the skin surgery usually caused by the local anaesthetic injection.  Swelling due to skin surgery usually settles 24 to 48 hours after the operation. If swelling does not settle or increases, this may indicate infection.

Wound opening: This is more likely to happen in people who overstretch their skin when they have had stitches inserted to close the wound. If you have stitches it is really important to limit manual work or exercise at least until the stitches are removed in order to reduce the tension on the wound and improve the healing process.

Bleeding:

• Bleeding at the time of skin surgery will be controlled using diathermy or cautery (heat to seal off blood vessels); you will not feel this as the area will be numb.
• Bruising may occur after skin surgery, especially if performed near the eye.
• It is common for the wound to ooze a little blood or fluid especially during the first 24 hours.
• To decrease your risk of bleeding after the surgery please follow the instructions in your ‘advice following surgical procedure leaflet’ about keeping the bandage and/or pressure dressing in place, minimising your physical activity levels and avoiding wound injury.

Infection: Wound infection rates are very low in our department and we do everything possible to reduce the likelihood of this happening.  Infection is more common in people who have diabetes, who smoke, are taking steroids or have poor health.

Altered skin sensation or muscle paralysis: Nerves may be disturbed during skin surgery.  This may cause changes in sensation and/or paralysis in nearby muscles.  This is normally temporary, however, can be permanent in some cases.

Frequently asked questions:

Can I drive myself home?

We usually advise that you have someone drive you to and from your appointment. If you are having a very minor procedure then it may be possible for you to drive home. If it is difficult to get to and from the hospital without driving yourself please discuss this with a member of the dermatology team who can advise you of how to proceed.

I take a blood thinning medication: is this a problem?

• Blood thinning medications such as Aspirin, Clopidogrel, Dipyridamole, Warfarin, Rivaroxaban, Apixaban, Dabigatran and Endoxaban may make bleeding more likely.
• Please tell the doctor/nurse if you are taking these medications.
• Please continue to take your medicines unless told otherwise.
• If you are taking Warfarin, please remember to check your INR at least one week prior to your procedure and bring your yellow Oral Anticoagulant Therapy (INR) book with you to your appointment. If your INR is more than 3.0, please contact us.

I have a pacemaker: is this a problem?

Cautery (sealing off blood vessels with electrical current) close to pacemakers, implantable devices and cochlear implants is used cautiously.  Please tell the doctor or nurse if you have any of these fitted.

My mother has dementia: what happens about consent for skin surgery?

• If you are a registered attorney or deputy (hold lasting power of attorney LPA for health and welfare) and are able to make decisions for a vulnerable patient or family member please bring these documents with you to the appointment.
• If there is no LPA in place we will discuss the treatment options with you and make sure that we involve you in any decisions that are taken ‘in the best interests’ of the patient.

I am having a procedure on my scalp: are there any special instructions?

• If you are having a procedure in a hair bearing area (e.g. scalp) please do not use hair products or greasy ointments on the day of your procedure.

Your doctor will inform you of the results from your skin surgery procedure when available and any further management if needed.

Written wound care advice will be provided.