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This factsheet is for people who are considering having a skin
lesion removed.
Lesions on the skin are lumps or bumps such as moles, cysts,
warts or skin tags. Most are benign (non-cancerous), but if they
are painful, unsightly or restrict movement, you may want to have
them removed.
Why remove a skin lesion?
Most skin lesions do not cause serious problems, but you may
want to have them removed for practical or cosmetic reasons.
Surgical removal of lesions is usually only considered if other
treatments such as medicines or creams and lotions are not an
option. Your GP will be able to discuss your options with you.
Surgery is also usually recommended to remove a skin lesion that
shows any sign of turning cancerous, for example, a mole that
has changed shape or colour.1 After these have been
removed, a small sample of the removed tissue is sent to a laboratory
for examination under a microscope. This is called a biopsy.1
How is a skin lesion removed?
Minor skin lesions, such as warts, may be frozen off with liquid
gas or treated with chemicals that are painted on such as salicylic
acid.
For more precise removal or for larger lesions, surgical removal
is often preferred.
Surgery to remove a skin lesion is usually a quick and straightforward
procedure that does not need an overnight stay in hospital. The
treatment may be available at a GP surgery or a hospital, where
it is performed as an out-patient or day case, which means that
you can have the operation and go home the same day.
What happens before surgical removal?
Your GP or surgeon will discuss how to prepare for your operation.
For example, you may be asked to give up or cut down on smoking
because this increases the risk of infection and slows the healing
of wounds.3
It is important to discuss the operation with your GP or surgeon
so you know what to expect. For example, a margin of skin around
the lesion may have to be removed as well as the lesion. This
will leave a bigger wound than you may expect from the lesion's
size.
The operation
The operation is usually performed using a local anaesthetic,
in which case the area around your skin lesion will be numb but
you will be awake. It can also be done under a general anaesthetic,
which means that you will be asleep throughout the procedure and
will feel no pain. The choice of anaesthetic will depend on the
size and location of your lesion.
The technique for removing the lesion depends on factors such
as its size and location. Your GP or surgeon will advise which
method is most appropriate for you.
Some lesions can be shaved down to the level of the surrounding
skin, either using a surgical blade or electro-surgery, which
uses an alternating current to destroy skin tissue.
Skin tags may be simply snipped off with surgical scissors.
Other lesions can be cut out entirely (excised) and the wound
closed up with stitches. The stitches are usually removed 3-14
days later, at an out-patient clinic or by a GP or district nurse.
If dissolvable stitches are used, these disappear on their own.1
Your GP or surgeon may apply a dressing to the operation site,
which will need to be left in place for 24-48 hours.4
This is not always necessary as some operation sites heal better
if left uncovered.
What to expect afterwards
Most people can go home within an hour or two of the procedure.
If you have had a general anaesthetic, you should arrange for
a friend or relative to drive you home and stay with you for the
next 24 hours.
Recovering from skin lesion removal
As the local anaesthetic wears off, the operation site may feel
sore. Painkillers such as paracetamol will help, and should be
taken as advised by your GP or surgeon.
You should take it easy for the first few days and take special
care not to bump or knock the operation site.
If you have had a lesion removed from your face, it may be helpful
to use extra pillows as this will help to reduce swelling and
bruising.4 You should not apply make-up to the operation
site until you have had your stitches removed.
Most surgical operation sites simply need to be kept clean by
daily washing with cool water.4 A recent wound, or
one that has just had the stitches removed, should not be soaked
in water. Your nurse, GP or surgeon will be able to give you more
advice on bathing.
After having a skin lesion removed, the operation site generally
heals fairly quickly. This can be about two to three weeks if
your lesion has been cut out or one to two weeks if it has been
shaved off.4
However, you should contact your hospital or GP if the wound:
- becomes more painful
- looks red, inflamed or swollen
- smells unpleasant
- leaks any sort of liquid
These may be signs of infection.
Deciding on treatment
Having a skin lesion removed is generally a very safe surgical
procedure. However, in order to give informed consent for treatment,
anyone deciding to have this operation needs to be aware of the
possible side-effects and the risk of complications.
Side-effects are the unwanted but usually temporary effects of
a successful treatment. For this operation, they are likely to
include:
- numbness caused by the local anaesthetic
- pain, swelling and/or bruising around the operation site
- a scar, which depending on the location of the lesion and
how much healthy skin has to be removed, may be noticeable
Complications are unexpected problems that can occur during or
after the procedure. Most people are not affected. The main possible
complications of any surgery are excessive bleeding during or
soon after the operation, developing an infection and an unexpected
reaction to the anaesthetic.
Complications of having a skin lesion removed include those listed
below.
- Most people's scars heal normally but a small percentage of
people have an inherited tendency to form scars that are unusually
red and raised. These are called keloids.5
- You may have bleeding under the skin, which may create a hematoma
where a pool of blood collects under the skin around the operation
site. This may need to be drained in a second operation.
- You may experience nerve damage as a result of an excision
in an area with extensive and shallow nerve branches. This is
usually temporary but can be permanent.
Other complications for this operation are uncommon. The chance
of problems depends on the nature of the lesion, the exact type
of operation used to remove it and other factors such as your
general health. Your doctor will be able to explain how the risks
apply to you.
References
- Simon C, Everitt H, Birtwistle J, Stevenson B, Oxford Handbook
of General Practice, Oxford, 2002:472-473, 912-915.
- Sterling JC, Handfield-Jones S, Hudson PM, Guidelines for
the management of cutaneous warts, BJD. 2001;144:4-11.
- Silverstein P, Smoking and wound healing. Am J Med; 1992;93(1A):22S-24S.
- Advice on the care of your wound following skin surgery. United
Bristol Healthcare NHS Trust.
www.ubht.nhs.uk
accessed 18 April 2005
- Keloids. Medline Plus.
www.nlm.nih.gov/medlineplus
accessed 16 March 2005
Published by BUPA's health information team, healthinfo@bupa.com,
July 2005
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