Dermatology - Following an Excision Biopsy

What does a dermatological surgical procedure involve?

You have been referred to the Dermatology Theatre for an Excision Biopsy. The information below aims to answer some general queries about the procedure.

What happens when I come for treatment?

• You will be treated in one of our operating theatres by one of our Consultant Dermatologists, Specialist Trainees or Specialist Nurse. There will also be two members of nursing staff present to assist in the surgery. Salford Royal is a Teaching Hospital, occasionally there could be a student nurse or student doctor present, if you do not wish to have students present, please inform one of the nurses prior to the operation
• All our procedures are performed under local anaesthetic, which numbs the area we will be operating on. This means that you will be awake during the procedure
• Local anaesthetic injections cause a stinging discomfort which will last for a few seconds. The local anaesthetic removes pain sensation, but you might be aware of touch and pulling sensations
• The numbness from the anaesthetic will normally last 2 hours. The time you will be in the department depends on the type of procedure being undertaken however, most procedures take between 15 and 45 minutes
• You can eat and drink as normal
• After the local anaesthetic has been injected the lesion will be removed with a margin of normal, healthy-looking skin. Stitches will be put into the wound. Usually you will have buried stitches under the skin which will dissolve over several weeks and also surface skin stitches which will need to be removed usually at your GPs in 5-10 days depending on the site of surgery (you will be informed on the day of the operation when to have them removed)

Will there be a scar?

• All skin surgery will leave some form of scar
• The type of scar often depends on the procedure, your racial background and the body site
• Sometimes in areas, especially on the upper back, shoulders and chest, scars can become raised, thickened, and sore or itchy. These are known as hypertrophic or keloid scars
• In addition, scars can stretch over time so that the scar becomes wider than it was at the end of the procedure. This is most common in areas under tension such as around joints

Will there be any pain?

• This often depends on the operation site but after most procedures there is little pain
• Large wounds or those in areas subject to pressure (e.g. the foot) or where there is a lot of movement (e.g. the shoulder) can be more uncomfortable
• Most pain is controlled by simple analgesia (pain relief) such as Paracetamol

Will I be able to drive?

• You will have a pressure dressing in place for 24 hours after your surgery
• If your procedure is on the face this may interfere with your vision or if your operation is on the leg might interfere with your ability to drive
• Operations around the eye and upper cheek can cause swelling or bruising of the eye which can also affect your vision. In these circumstances you are strongly advised not to drive

After effects of surgery

• All skin surgery inevitably cuts small nerve fibres; this can result in numbness or pins and needles around the operation site. This change in sensation can last for a few weeks or occasionally months
• Wound infections are an uncommon but recognised risk of skin surgery. Wound infections should be treated as soon as possible with antibiotics. Heat, pain, redness and swelling around the site 4-5 days after surgery could be a sign of wound infection. Please contact your GP if you are concerned that you could have a wound infection
• Overstretching of the scar initially (especially in sites of high tension) can cause the stitches to come out and leave the wound open. Hence, it is vital to avoid strenuous exercise/gym work or heavy manual work for 4 weeks. The healing process continues even after the stitches are removed
• Occasionally reactions to buried (absorbable/dissolving) stitches can occur. Buried stitches are used to provide support to the deeper parts of a wound. These reactions are rare but can occur several weeks after surgery as the stitches are absorbed
• There may be some bleeding after surgery, however, this is usually minor

Medications

Please bring a copy of your most recent prescription when attending your operation.

Your medication should have been discussed with you at consultation.

If you are taking Aspirin, Clopidogrel, Dipyridamole, Warfarin, Rivaroxaban, Dabigatran or Apixaban these can increase your risk of bleeding after surgery however, unless instructed otherwise by your doctor you should continue to take your medication.

You should also make your doctor aware if you take Propranolol, this is a drug known as a beta-blocker which can be used for high blood pressure, anxiety, or tremors.

Results

You will always be contacted about your results. Your doctor will contact you by letter regarding the results in approximately 6 weeks or you may be asked to come back to a telephone or face to face clinic appointment.

If you are not contacted, please contact the responsible consultant’s secretary, the number is on the top right of the clinic letter.

If you have any queries about your surgery, please contact the dermatology theatre clerk on 0161 206 1856 or
Email: dermatology.theatre@nca.nhs.uk