Minor skin surgery
Issued: September 2022
Review September 2024
Ref: A-296/onc/RD/Minor skin surgery v5
PDF: Minor skin surgery final January 2018 v3.pdf[pdf] 214KB
What is skin surgery?
Skin surgery is usually a simple procedure where a doctor or nurse will carry out an operation. If the surgery is to be carried out on the head or neck, or in an area where you need to stretch, it is advisable to arrange for someone to drive you home after your surgery. This will prevent any unnecessary trauma to the area being treated and will avoid invalidating your insurance if the local anaesthetic impairs your driving.
Will I need a local anaesthetic?
All skin surgery requires an injection of local anaesthetic. This means:
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You can eat and drink as normal.
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You are not put to sleep.
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In most cases you will be ready to leave the hospital within an hour of your operation.
The injection may be uncomfortable for 5-10 seconds whilst being administered under the skin. If you are concerned about having injections, you can consult your GP prior to the date of your surgery as it may be possible for them to give you a prescription for some numbing cream that can be applied to your skin at home to reduce the discomfort of the injection.
The skin will remain numb from the anaesthetic for up to 2 hours. There may be a temporary “whitening” of the skin at the injection site until the anaesthetic has worn off. The injection may also leave you with a bruise, particularly on delicate areas of skin, e.g., near the eye or on the shin.
What is a biopsy?
A biopsy is the removal of tissue for study and diagnosis, under a microscope. It is sometimes used to completely remove lesions. There are several ways of carrying out a biopsy. These are:
Punch biopsy: a round piece of skin is removed for testing in the laboratory using a specially designed instrument. Stitches are sometimes required.
Shave biopsy: some skin lesions can be shaved off the skin leaving a small wound, which is then sealed by cauterisation.
Curettage and cautery - some skin lesions can be scooped out with a surgical cutting spoon, and the wound is then sealed with cauterisation.
Excisional biopsy: some skin lesions need cutting out of the skin, and these wounds will require stitches. The wounds from these may be about 3 times larger than the lesion was originally.
Skin grafts: in some cases, a skin graft is necessary when a large lesion has been removed. A piece of skin is taken from another area of the body and used to repair the wound.
Skin flaps: large lesions, or lesions in awkward positions, may require a plastic surgery technique, to enable the wound to be stitched. This may take between 45 minutes to 1 hour, and can be a larger wound than you expected
Stronger pain relief may be prescribed if needed.
What are the benefits of surgery?
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A specimen can be sent for analysis to confirm a diagnosis.
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The lesion will be removed.
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Symptoms may be improved.
You will probably have some stitches, although this is not always necessary. This depends on the procedure being carried out.
What are the risks of surgery?
All skin surgery carries the following risks:
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Bleeding.
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Scarring.
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Wound infection.
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Wound breakdown/splitting.
Bleeding
Bleeding at the time of surgery will be minimised by the epinephrine (adrenaline) used in your local anaesthetic.
Diathermy (heat applied to the wound) will control bleeding. Diathermy close to pacemakers and metal implants is used cautiously.
Tell the doctor or nurse if you have a pacemaker of Implanted Defibrillator fitted
There are some medicines which thin the blood and can make bleeding more likely. Please tell the doctor or nurse if you are taking any blood thinning medications such as Warfarin, Aspirin, Dipyridamole, Clopidogrel or Rivaroxaban.
If you are taking Warfarin, please ask your GP to check your INR within 48 hours prior to your operation to make sure that your INR is below 3
Bleeding after surgery is minimised by following instructions given to you by your surgical team on the day about activity levels and leaving any pressure dressings in place.
Bruising may also occur from bleeding under the skin during your procedure.
Will I have a scar?
All surgery involving the skin will leave a scar. If a lesion is being completely removed, generally the scar will be three times as long as the original lesion is wide.
Keloid scars: these are genetically influenced (unique to you) scars, with abnormal healing extending beyond the site of surgery. For people affected by this type of healing, lesions on the chest, upper arms and back are common sites. Keloid scars do not resolve with time.
Hypertrophic scars: these scars happen from a vigorous response to injury. They may be more “bumpy”, but tend to flatten over time. It can take up to 2 years for these scars to flatten.
Stretched scars: these happen when the skin surgery has taken place overactive muscles. Adhesive tapes worn for 1 month after surgery can help. The doctor/nurse may use stitches that dissolve under the skin to help prevent this problem occurring.
What will the area look like after my surgery?
Most of the time scars heal well and tend to look better and better with time. It can take months to years for the scars to full settle. Sometimes wounds or scars can lead to a poor look or appearance after surgery which some patients may find upsetting. Further surgery may help but sometimes the change is permanent or difficult to correct.
Is there a risk of a wound infection?
Wound infection may occur. It is more likely in those who are diabetic, smokers, on high doses of steroids, have other serious medical conditions or who are in poor health. Skin lesions that were ulcerated or crusted before surgery may be at greater risk of infection. Wound infections may cause the wound to gape or the stiches to fail, and scarring may be more pronounced following a wound infection. Infected wounds tend to be red, weepy, and painful.
Will my wound breakdown or split?
This is more likely to happen:
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In smokers.
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Where the skin is over stretched due to manual work or exercise.
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Following a wound infection.
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Where the wound needs to be closed under tension when stitched together.
Will I experience pain?
Pain may be experienced after surgery. It is usually relatively mild and controlled with Paracetamol. Aspirin should be avoided. More severe pain may indicate wound infection. Advice should be sought from your GP if you are concerned.
Will there be any swelling?
Initially, there will be swelling caused by the local anaesthetic injection; this can be quite obvious close to the eye or lip. A degree of swelling after surgery is also common. It is part of the natural healing response. Swelling normally reduces 24-48 hours after surgery. If swelling is prolonged seek advice from your GP.
Will I be able to drive after surgery?
It is difficult to predict how you will feel after surgery so we would ideally recommend you do not drive home following the procedure, especially if on the head and neck, lower legs, or a larger procedure involving a skin flap or graft. Any driving after this depends on your recovery and whether you feel in full control of the vehicle so it is best to consult your insurance company for advice.
When can I return to exercise?
You will heal better with less risk of complications if you are able to avoid exerting yourself after surgery. This is particularly important after a bigger procedure or those on the head and neck. We advise that you avoid stooping forward/bending down or doing any activity that raises your heart rate and blood pressure for at least a week and may advise longer depending on your surgery.
Will I have altered skin sensation or muscle paralysis?
During surgery, there may be nerves that are disturbed close to the lesion. Altered skin sensation or muscle paralysis in the area of surgery may happen. Normally this is temporary and should recover within 6 months, however occasionally this may be more permanent. Scars themselves may have altered skin sensation.
When will I be told the results?
Your hospital doctor will write to you and your GP with your results of the biopsy within six weeks of your surgery. If you have not heard from us by six weeks, then please contact your consultant’s secretary.
Who can I contact?
If you have any questions or concerns, about your surgery or medication, please inform your nurse or the doctor in charge of your care, or contact:
Dermatology Department:
Monday to Friday 9.00am until 5.00pm
Telephone: 01752 439712
Plastic Surgery Department
Monday to Friday 9.00am until 5.00pm
Telephone: 01752 431024
For GP out of hours, contact your surgery
Derriford Switchboard: Telephone: 01752 202082
Textphone (For Deaf or hard of hearing): 0845 155 8281
Useful websites
www.direct.gov.uk
www.nhs.uk
