Skin surgery

Your clinician (doctor or specialist nurse) has recommended that you have skin surgery. This leaflet aims to answer questions and give instructions about your procedure.

If after reading this leaflet you have any further questions or concerns, please contact the Dermatology team or speak to your surgeon on the day of your surgery.

We aim to give you the best service possible and do appreciate any feedback.

Please read all of this leaflet carefully

What should I do before I come into hospital for my procedure?

• Eat breakfast or lunch before coming into hospital.

• Shower or bathe, as you may not be able to for a few days after your surgery.

• Wear comfortable clothes, that allow us to easily get to the area we are operating on.

• If the lesion is on your face, do not wear make-up.

• Do not drive after your procedure. Please arrange for someone to take you home after your procedure, unless you have been told otherwise.

• Holidays / Special events. You may have a wound dressing that needs to be removed at a follow-up appointment, which may be difficult if you are going away within one to two weeks of your surgery. Please let us know if you have any events coming up.

• Think about taking time off work if you do a physical job.

• Smoking can affect your ability to heal well. Avoid smoking for at least 2 weeks before and after your surgery. If you need support to stop smoking, please contact One You Kent on 0300 123 1220, or email.

• Allergies: please let your doctor know if you have any allergies to medicines or latex. It is unlikely to affect your surgery, unless you have had a bad reaction to local anaesthetic. Please bring documentation of this to your appointment.

• Let us know before the day of your surgery if you have a pacemaker or defibrillator. These may affect what equipment we can use, but should not prevent your surgery.

Drugs and medication

• Certain drugs or medications may affect your surgery. Please make sure you bring to hospital a list of the drugs prescribed for you by your doctor. Include any over-the-counter medications, such as vitamins that you may buy yourself.

• Warfarin. Even if your INR is stable you need to have an extra test in the week before your operation. If your INR level is over 3, please contact the department on 01227 864365 or 01227 783020. Please bring your yellow warfarin book to your appointment.

• Let us know if you are taking blood thinning medication or anti-clotting agents, for example rivaroxaban, aspirin, or clopidogrel. These do not always need to be stopped, but it is useful to let the doctor know if you take these.

• Some over-the-counter medications may increase your risk of bleeding. Please avoid these for at least a week before and after your operation. This includes vitamins (such as vitamin E) and herbal supplements (such as gingko or garlic).

What should I do when I arrive at the hospital?

Your appointment letter will tell you where to go when you arrive at the hospital.

Patients living with dementia. If the person needing the operation does not have capacity to consent to their procedure, they must come to hospital with:

• someone who knows them well, and

• if it exists, has power of attorney for medical decisions (you will need to bring the evidence for this to the hospital).

How long will I be in hospital for?

Please allow 1 to 2 hours for your hospital appointment.

How do I get to the hospital?

All hospital sites have patient car parking (charges apply) and main bus routes serving them.

G4S provide non-emergency patient transport. This is for patients whose health means they cannot get to or from hospital in any other way. You can find out if you are eligible for patient transport by calling 08000 960 211.

For up-to-date information, please go to our Getting to our hospitals web page.

What procedures are carried out in the Skin Surgery Clinic?

Excision is the complete removal of the skin lesion. The skin lesion is then sent to Pathology for testing. After we remove the lesion, we usually repair your skin with stitches, to leave as neat a scar as possible. You may need a local skin flap or skin graft repair to close your wound. If you need this, your doctor will discuss this with you.

Biopsy is where we take a small skin sample for testing, to make sure we give you a correct diagnosis. Your wound will be very small, usually less than 1cm and closed with stitches or left to heal by itself (like a graze).

Curettage and cautery is where we remove the skin lesion by scooping out or scraping off the skin. An instrument is then used to seal the surface by burning.

Will I have an anaesthetic?

Yes. You will have local anaesthetic injected around the area to be treated. The injection will sting for a short time, but the operation should be pain free. You will be awake the whole time. Please let the doctor or nurse know if you feel any discomfort during your procedure, as extra anaesthetic can be given if needed.

Who will perform my surgery?

A doctor performs most surgeries, with a nurse in attendance. We also have specialist trained nurses who perform small excisions or biopsies.

What complications can occur after surgery?

• Inflammation is normal, and presents as a slight redness around the stitches. It usually settles down when we remove your stitches.

• Infection. You may experience pain, swelling, and redness, or pus coming from your wound. If this happens you should contact NHS 111 and they will decide if you need antibiotics. You may also contact the nurses on the Dermatology Unit during working hours.

• Bleeding. If this happens, elevate (raise) the affected area and apply continuous pressure for 20 minutes. If the bleeding continues after 20 minutes of constant pressure, contact the Dermatology Department or NHS 111.

• Most procedures will have some bruising, in particular around the eyes.

• You may feel some pain and discomfort after your procedure. If this happens, take paracetamol.

• Scarring. There is no such thing as a scarless surgery. Usually the length of the scar will be 3 to 4 times the width of the removed lesion.

• You may have a wide stretched scar. This is more likely to happen if:

  • the surgery was over large muscle groups and near joints, or

  • if you started activities that stretched the scar too early.

• Hypertrophic or Keloid Scars happen if there is an over-reaction of the fibrous tissue / scar in your skin. It does not occur immediately, but develops after a few weeks or months. Keloid scars are more common on the front of the chest, arms, and back, and in scars which have not been sufficiently immobilised. They are more common in Afro-Caribbean skin types. If you have had any previous problem with thickened scars, please let us know.

• Bursting of the wound (dehiscence) is very uncommon. The most likely time for this to happen is just after your stitches have been removed or if your wound has become infected. Taking extra care for a week or so after your stitches have been removed, will reduce the risk of this happening.

• Nerve damage. Sometimes, small nerves in the skin will be removed with the lesion. This may result in numbness around your wound, which may be permanent. Damage to nerves that supply muscles is very rare, though can happen in certain areas on your face. Your doctor will discuss these risks with you before your procedure.

• Pigmented scars. To reduce this risk, you should put sun protection on your scar for the first year following your surgery. We recommend you use a high factor sunscreen (at least SPF30). This should lead to a pale scar, which should be less noticeable.

Will I have stitches?

Most excisions will need stitches to close the wound. These are often dissolvable, but occasionally you may need to have them removed. However, we do sometimes leave the wound to heal by itself. Your doctor will discuss with you how to achieve the best outcome.

You will have a dressing placed over your wound. Before you leave hospital, you will be given written advice on how to care for your wound at home.

When can I resume my normal activities?

Do not swim, play sports, or exercise while your stitches are in place. Depending on the size and site of your surgery, you may be asked to not take part in activities that might stretch that area for a longer period of time (for example 3 to 4 weeks) after your stitches have been removed. Please ask if you are not sure.

When will I get my results?

We will write to you with the results of your surgery / biopsy as soon as possible. If you have not heard from us after 6 weeks, please call the Dermatology Department on 01227 864365 or 01227 783020.

Contact details

If you do have any questions or concerns, including if your lesion seems to be growing whilst you are on the waiting list, please contact the Dermatology Department on 01227 864365 or 01227 783020.

If you would like to discuss the time or date of your appointment or you wish to cancel it, please phone 01227 783020.