Minor Dermatological Surgery for Benign Skin Lesions

Surgery for removal of a simple skin lesion is usually performed under local anaesthetic while you are awake. The local anaesthetic is injected into the area surrounding the lesion to cause localised numbing. Patients may experience some brief stinging or tingling for a few seconds as the anaesthetic is injected although the area will become numb very quickly. Sometimes a topical anaesthetic is administered to pre-numb the skin before the local anaesthetic is injected for even greater comfort (although this is not usually necessary). During the procedure, you should not feel any pain at all. You may, however, feel some pushing or pulling, which is entirely normal. Some patients actually fall asleep naturally during the procedure or listen to music.

An elliptical excision, as the name suggests, involves excising the lesion with a margin of surrounding skin as an ellipse. The orientation of the ellipse, and therefore the scar, will depend on the lesion’s dimensions and location but is designed to run parallel with existing skin creases. The blood vessels are cauterised using diathermy to stop bleeding and then the wound is closed very neatly as a single line using sutures (“stitches”). Usually, the sutures will need removing in 6-14 days depending on where the lesion is (sometimes longer for lesions where the skin is often stretched and under tension such as the back). Occasionally, absorbable sutures may be used for the deeper layers or even on the skin surface, which will disappear by themselves.

A shave excision involves cutting the lesion as flush with the surrounding skin as possible (occasionally slightly deeper as a shallow saucer shape for pigmented lesions). We often use specialist blades as this tends to give better control of depth than a standard scalpel. As the skin is left intact, there is no need for sutures. There is also usually less bleeding than with an elliptical excision but sometimes gentle cauterisation is performed at the base of the wound.

Following both elliptical and shave excisions, simple shower-proof dressings are applied and should be kept in place until your next appointment. After a brief stay in the recovery area, you will be discharged with specific aftercare instructions to follow at home. Post-operative antibiotics are not usually necessary but may be given under certain circumstances.  The local anaesthetic will wear off after 2-3 hours. You may experience some mild soreness and tightness for the first 1-3 days, which should be well controlled with simple paracetamol or ibuprofen. You will be given a date to return to the clinic for a wound check and, if applicable, for removal of sutures by the practice nurse.

Full post-operative care advice will be given and you will be able to resume your normal activities the same or next day.

Please keep the wound clean and dry to avoid infection while it heals. You can wash around the area but do not soak the wound in water, apply makeup until the wound has healed, or shave over stitches if they are in the beard area. If the wound is in an area of the body (e.g. back) where it might be stretched or under tension, avoid strenuous movements or exercise for 2-3 weeks after your operation.

The dressing may be slightly stained by some post-operative bleeding, but this is normal. If the bleeding persists, put a new dressing on top of the original one and apply pressure firmly for 20-30 minutes. If still bleeding after this time, please seek medical attention by contacting the clinic in the first instance, and do not remove the original dressing.

Surgery around the eye or forehead can sometimes result in bruising such as a black eye but will disappear after approximately one week. Lying on a few extra pillows at night will minimise any bruising.

If you have an upcoming holiday or event, it is advisable to book a convenient appointment date to allow time for the wounds to heal or for any stitches to be removed. If you plan to go away, we usually recommend having surgery at least two to four weeks beforehand, depending on the lesion and procedure. More specific instructions will be provided at your initial consultation.

It is our policy to send all moles (and some other lesions) for histological analysis for reassurance and peace of mind. The specimen is sent to a laboratory where it is cut into multiple sections and each slide analysed under a microscope by a pathologist. Histological stains may also be used to look for specific cellular elements. Rarely, moles that appear clinically normal on the surface can have abnormal microscopic features deeper down. The only way to detect these changes is by histological analysis. Please note that, although we routinely send most lesions for histological analysis (except simple lesions such as skin tags or warts), we only remove lesions that are not clinically suspicious or worrying (i.e. only benign-looking) at the time of initial assessment.

After an elliptical excision, a linear scar will form as part of the normal healing process. However, although initially red, this usually fades with time to an almost skin tone colour, this can take up to a year or sometimes even longer. After the sutures have been removed and any inflammation subsided, you can massage any facial scars with Bio-Oil^® or moisturising cream twice daily for 3-6 months to improve scar tissue appearance. We recommend using a silicone gel such as Kelo-cote^® for optimum results as this has been clinically proven to reduce scarring and protect healing wounds from UV damage caused by sunlight.

With shave excisions, there is very little scarring although there may be a scab which takes a few days to weeks to drop off. The same aftercare should be used as above making sure to keep the wound moisturised and protected from the sun using a broad-spectrum sunscreen with UVA filter. Certain individuals can develop hyper-pigmentation (where the skin becomes darker than the surrounding area). These are usually self-resolving although can take over a year to fade (but can be helped by using certain topical creams on a routine basis).