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What to expect with skin surgery


Let's go through the most common questions about skin surgery

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Will it hurt?

That’s the number one fear of most people when thinking about having things removed on their skin! The good news is that in experienced hands, any skin surgery is likely to hurt a lot less than you might imagine. Of course, it will involve a small injection, but this is usually no worse than a skin pinch or a minor sting from an insect or a plant. The sensation is over in a matter of seconds and then the area is numb. Some people have been put off by bad past experiences or by grim tales from well-meaning friends, but actually, it’s really common for our patients to incredulously ask ‘Was that it, I hardly felt a thing?!’ after the skin anaesthetic or even the whole procedure is done.

What are the different types of skin surgery?

An experienced doctor will be able to choose the best way to biopsy or treat your particular skin lesion.

The three most commonly used methods are:

1. Curettage and cautery. This is where the skin lesion is removed by a special surgical ‘shave’ blade. After the skin lesion is removed a surgical device is used to stop any minor bleeding with heat. This is often used to treat surface skin lesions like skin tags or crusty ageing warts.

2. Punch biopsy, which is where a small (usually 4 mm) round sample (a bit like a hole punch in paper!) is removed and the hole closed with 2-3 small stitches. These are normally removed after 7-10 days. A punch biopsy is most often used to take a sample to send to a lab to find out exactly what the skin lesion (or rash) is. It can also be used to treat very small skin blemishes.

3. Excision, where the whole skin lesion is removed and the wound stitched. The stitches are normally removed after 7-14 days depending on body site. Dissolvable stitches can be used, but aren’t always the best option as they can take too long to dissolve and leave stitch marks in the skin even after you have long healed. Sometimes a skin lesion is removed with a few millimetres of healthy-looking skin around to help ensure the blemish doesn’t come back.

Can I be put to sleep if I’m needle phobic?

This can, of course, be considered if the skin lesion is very large or in a very awkward location. But you might be surprised at what can be achieved by using simple local anaesthetic in a clinic setting. Again, an experienced doctor will be able to assess your particular problem and explain the best way to proceed. Needle phobia is common and can be a real problem for some people. However, don’t put off having a skin blemish assessed and examined by a doctor for fear of the needle - it is hugely important to catch things early.

Almost always, it’s a case of having a consultation and examination first anyway and any procedure would be planned for later. Who knows, you might not need it! Speak to your doctor or nurse about what it is that puts you off. More often than not, there are ways around fear of needles, for example to using a numbing cream (e.g. EMLA cream) and put it on the area an hour or so before the procedure. This can sometimes make the initial sting almost totally pain free. Another trick I personally like is to cool the skin with an ice cube for a couple of minutes before doing the first tiny injection. I reserve it mostly for children, but I am happy to do the same for any adult who wants it!

What is the recovery time after skin surgery?

The speed of healing depends on many factors, including body site, age, your health, whether you smoke and how well you are able to look after the wound afterwards. As a rule of thumb, plan to take it very easy for 3 days or so after a minor skin procedure including laying off any vigorous exercise and opting out of household chores!

Usually, by day 4 the site will be dry and any swelling has gone down and you can start to do more. If you have stitches the best advice is not to do anything too vigorous, and not to cause any pull on the stitches, until they are removed.

How do I know if my doctor or nurse is any good at skin surgery?

Good question - And the answer is that this isn’t always easy to find out for sure! Look for a doctor who works in a regulated clinic setting.

Skin surgery should only be carried out in clinics which are registered and regulated by the Care Quality Commission (CQC) in England, Healthcare Inspectorate Wales (HIW) or Healthcare Improvement Scotland (HIS). Doctors working in dermatology, general surgery and plastic surgery will have the most experience, but there are many good skin surgeons out there including General Practitioners and Nurse Practitioners.

There is nothing wrong with asking the doctor or nurse about their regulation, training and experience. Or ring up a clinic and ask the receptionist.

What are the problems after skin surgery?

Significant problems after minor skin surgery are very unusual. Nuisance issues include skin infection, bleeding, discomfort, pulling sensation, numbness around the wound, the wound opening up (very uncommon) and scarring. The chances of any of these being real problems are certainly less than 1:10 and the vast majority of these minor issues settle in time (weeks or months) with or without further treatment.

A responsible surgical practitioner will make themselves easily available to you after the procedure via phone, email or even personal mobile telephone, say if the procedure is on a Friday and the clinic closed over the weekend.

What does skin surgery cost?

In a regulated clinic with an experienced doctor expect to pay around £200 for the treatment of a minor skin tag or superficial blemish. Prices for larger procedures with stitches will usually start at £400 or so and very extensive or multiple procedures may be close to the £1000 mark.

It is considered good practice to send ALL skin lesions for analysis at the pathology lab and this will add £150-250 to the bill. A dermatologist or a doctor who is very confident at clinical diagnosis may dispense with this requirement for skin tags and very minor blemishes, with your consent.

Generally, the prices are much higher at private hospitals, but it may be an idea to ring around respectable providers for quotes.

So, after reading all that you now have the answers to the most common questions we hear in our skin surgery work. Having skin lesions removed really isn’t something to be afraid of and generally is a quick and painless experience for most.
By Dr Keli Thorsteinsson, MD DPD
Specialty Doctor in Dermatology
Written by Keli Thorsteinsson
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