Rolle Dermatology & Skin Surgery

If you have been referred for an appointment to see a member of our Dermatology Team, as part of your assessment, we may need to undertake a diagnostic sampling or surgical removal procedure at the time of your appointment. This page provides you with both pre-operative (prior to attending your appointment) and post-operative advice for any procedure undertaken on the day, or at another scheduled time.

1. Preparation for your surgery

Should you require a surgical procedure this may be performed on the day of your appointment in clinic here at Treetops Surgery. The procedure will be performed under a local anaesthetic. You are able to eat and drink as usual prior to the procedure. It is recommended that you have someone accompany you to the hospital as you may not be able to drive home, particularly after surgery to the face, neck, head or hands.

Please do not stop taking your usual medication ahead of your appointment; and check to see if any of the following areas are applicable to you:

Smoking: Impairs the skin’s ability to heal. If you are able to stop smoking for 2 weeks before and after the operation the overall wound healing will be improved.

Blood thinners:

• Aspirin. If you take a ‘mini aspirin’ daily continue to take it, but please inform us at the time of surgery.
• Warfarin. The INR ideally should be less than 3. Please get your INR checked 2 days before the procedure. Do not alter your warfarin dose unless this has been advised by the doctor prescribing the warfarin. Please bring your anticoagulation book to the operation.

Medical Conditions: If you have diabetes, epilepsy, a bleeding disorder (including a low platelet count), a pacemaker, cochlear implant or any implantable device, prosthetic heart valves or any other significant medical conditions then please let us know.

Allergies: Please inform of any allergies, particularly to antibiotics, dressings, latex and anaesthetics.

2. The procedure

Local anaesthetic will be injected into the site for your required surgical procedure. This causes a stinging sensation lasting several seconds. The area then becomes numb and no discomfort should be felt. The lesion is biopsied or excised and sent to the laboratory for pathological analysis (checked under a microscope). The wound may be closed with stitches – on the skin surface and often underneath the skin (these will dissolve over several months). A dressing will be applied. If you have had a skin flap or graft performed the dressing may be quite large and bulky. Occasionally, you may be prescribed a course of antibiotic tablets to be taken after the surgery. It is important that we know if you have any antibiotic allergies. Further information on the types of surgical procedures carried out by our surgical team are provided at the end of this page.

3. Skin biopsy analysis

All skin surgery specimens are sent to our pathologists for analysis. The result is usually available within 4 weeks but may take longer if further analysis is needed to reach a diagnosis. A member of  our team will either write to you, or contact you over the phone with the results, or request a follow up appointment to see you.

4. Care for your surgical wound

Keep the area completely dry for 48 hours. At this stage the dressing can usually be removed. The area can be gently washed once a day, and you can apply a thin smear of ointment. If you prefer you can keep the wound covered with a simple dressing which should be changed daily. If the wound starts to bleed, apply firm continuous pressure for 30 minutes. Slight bleeding in the few hours after surgery is common and is aggravated by activity. Hot drinks or bending down can cause bleeding, especially on facial wounds. Swelling and bruising is common, especially after facial surgery, and can be lessened by use of an ice pack. Use extra pillows after facial surgery and elevate the leg after lower limb surgery.

Do not use make-up near a wound until the surface has completely healed. Avoid swimming until the stitches are removed. The scar will be strong by 30 days – and is at its weakest during the first few days after the stitches have been removed. Too much activity can put strain on the healing scar. This can lead to stretching of the scar or bursting of the wound. Surgical wounds on the lower leg generally take a lot longer to heal.

5. Pain Care

When the local anaesthetic wears off after 2 to 3 hours, the area may be uncomfortable. Take 2 paracetamol (500mg) tablets every 4 to 6 hours (a maximum of 8 tablets in 24 hours). It is better to avoid aspirin or ibuprofen as pain relief on the day of the procedure as occasionally they can contribute to bleeding. Alcohol – do not drink any alcohol for 24 hours after the operation.

6. The scar

All skin surgery results in permanent scar formation. Scar tissue is red for 3 to 6 months and then usually fades to white. The appearance of a scar usually improves over 12 months as it ‘matures’.

7. Removal of stitches

This will be between 5 and 21 days after the procedure depending on the part of the body. This can either be done at (trust name) or by arrangement with the practice nurse at your GP surgery.

For further information please contact either:

Dr Willcock for skin cancer work or Dr Harris for benign skin lesion work, via reception on 01395 226540.

Types of Surgical Procedures

This section provides a brief overview of the following procedures which may / will be necessary as part of your treatment:

• Punch Biopsy Incision Biopsy Excision Biopsy
• Wider Excision or Wide Local Excision with Skin Flap

Punch Biopsy

A punch biopsy is a procedure in which a small circular shaped piece of skin is removed and sent to the laboratories for analysis, to establish a diagnosis. The patient remains awake during the procedure and the area is injected with a local anaesthetic to numb the skin being operated on. The skin is closed with one or two stitches that can be removed after five to fourteen days (often by a practice nurse at the patient’s GP surgery). Dissolving stitches are also occasionally used.

Incisional Biopsy

An incisional biopsy is when part of a skin lesion is removed for analysis, using a scalpel (sharp surgical blade). The patient usually remains awake during the procedure and the area is injected with a local anaesthetic to numb the skin being operated on. The skin is closed with a few stitches that can be removed after five to fourteen days (often by a practice nurse at the patient’s GP surgery). Dissolving stitches are also occasionally used.

Excision Biopsy

An excision biopsy is complete removal of a skin lesion/mole. As for an incisional biopsy, the patient usually remains awake and the area is closed with a few stitches.

Wider Excision or Wide Local Excision

This surgical procedure is sometimes performed on patients who have had previous surgery for skin cancer. The surgeon removes a margin of normal looking skin from around the operation scar. This is to make sure that no skin cancer cells are left behind. The amount of skin removed depends on how deeply the skin cancer had gone into the skin, but it is often at least 5mm and can be up to 3cm of further tissue taken from around the original site. The patient will remain awake as we the procedure is under a local anaesthetic.

Skin Flap

This technique is used for awkward sites or larger wounds, where adjacent skin is moved into the wound area, by making further cuts in the skin, and stitched into place. The skin comes from beside the wound, so is usually a good match for colour and texture. The moved skin is still attached to the body, so has a better blood supply than a skin graft, making it more likely to heal quickly and survive in its new position. The area is protected with a dressing and the stitches may remain in place for 5-14 days, depending upon the site operated on.

Secondary Intention Healing

Occasionally a wound will be left open (rather than being stitched together) and left to heal by itself, filling in and closing up naturally. This often avoids further (more extensive) surgery and can regularly produce excellent functional and cosmetic results. It will mean that you will need regular dressings to the area for up to six weeks (possibly longer on the lower leg), but the time to full healing depends on the size, depth and site of the wound.

Dressing changes may be carried out by your local practice nurse, or in some cases patients/relatives might be taught how to care for and redress the wound at home. Sometimes a single running suture is placed around the wound to pull the edges closer to each other. This will normally be removed after 7-14 days.