Pre-operative advice for children who are due to have skin surgery under local anaesthetic

Information for families

It will have been explained to you that your child needs to have a small operation to remove a skin lesion or obtain a sample of skin. This leaflet explains the operations and answers some frequently asked questions.

After your operation you will receive a different leaflet providing information on wound care, stitch removal and getting results.

What should I do before the operation?

An appointment time will be arranged with you by the booking team.

You may be asked to apply an anaesthetic cream to the area at home, one to two hours before your child’s appointment time. This will need to be covered with a clear adhesive dressing which will be provided. Cover the adhesive dressing with clothing in young children as they may otherwise try to remove it.

They can eat and drink as normal.

You may wish to bring something as a distraction on the day – please see suggestions at the end of the leaflet.

What happens on the day?

Your child will usually have the procedure in clinic 7, level 3, Addenbrooke’s Hospital as an outpatient procedure.

On arrival in clinic 7 please report to the clinic reception desk. You will be asked to wait in the waiting room.

You will then be taken through to the theatre room, where the doctor will discuss questions, and ask you to sign a consent form. If your child is on any medications or is allergic to any medications, please inform the doctor. You will stay with your child throughout the procedure.

What kind of procedure are they having?

The type of procedure will be discussed with you and your child in clinic; details of the procedures are given below.

Punch skin biopsy (approximately 30 - 40 minutes)

This is a short procedure to remove a small piece of skin tissue for examination under the microscope. Sometimes it is necessary to grow skin cells (fibroblasts) for more complex analysis. It will be explained to you before the biopsy what type of testing is required.

A skin biopsy is usually performed to determine or confirm a diagnosis that cannot be made by blood tests.

What does the skin biopsy procedure involve?

Skin biopsies are usually done while your child is fully awake. A small area of skin will be numbed. Depending upon the site, young children may like to sit on your lap or lie with you on the couch during the procedure.

Your child may find it helpful to be distracted during the procedure – there are some suggestions at the end of this leaflet.

The anaesthetic cream and dressing are removed and the area cleaned. Local anaesthetic is injected and a slight burning or warm sensation may be felt. Once the area is numb, the skin biopsy needle is gently inserted and 4mm (<1/4 inch) of skin is removed. This is usually felt only as a touch sensation and takes only a few minutes. The biopsy site usually bleeds slightly after the procedure and is held closed either by a stitch which may need to be removed after a few days, or by Steristrip® ‘paper stitches’. A dressing will be placed over the area.

This skin is then sent to the laboratories.

You will be given an information sheet on how to look after the area and the dressing and your child can then go home. A small scar similar to a chickenpox scar will form.

Excision of a skin lesion (40-60 minutes)

The procedure is similar to that described above under ‘skin biopsy’, but the whole skin lesion is removed with a margin of normal skin around the edge. The bleeding is stopped with an electric cautery machine, and then sutured with several stitches above and below the skin surface. The scar will be longer than the lesion removed.

When your child goes home

The biopsy site may feel uncomfortable for one to two days, especially if it is knocked, and Calpol (paracetamol) may be given. Your child can return to school or nursery the day after the biopsy.

You should keep your child’s wound and dressing dry for 48 hours. Any stitches will require removal by the nurse at the GP surgery 5 - 14 days after the procedure. Your child should avoid activities such as sport and strenuous exercise for 14 days after the procedure.

How long will it take to get the test results?

If it is just necessary to look at skin under the microscope, results will be available in approximately six weeks. Growing fibroblasts takes at least six weeks. Analysis of genes responsible for a disease (carried on DNA) may take several months.

Does the operation carry any risks?

Bleeding

It is normal for a small amount of blood to come through the dressing. Any heavier bleeding should be stopped by applying firm pressure to the dressing for 15 minutes. If bleeding continues, you should contact your GP or accident and emergency department.

Infection

Occasionally a wound can become infected, and this will show as increased pain, swelling and redness of the wound after a few days. If you are concerned about infection, please see your GP or this department for advice.

Scarring

The scar is likely to be red initially, but this fades over a period of weeks to months. You will be left with a permanent scar, the length and width of which depends on the operation performed.

Suggestions for distraction during the procedure

Your child may wish to bring something to distract them, such as a handheld computer game or music, books or story tapes, a cuddly toy or a toy to look at (such as a kaleidoscope or rain-maker).

Breath control can be done by pretending to blow a feather up into the air, blowing up a real or imagined balloon or by blowing bubbles. Older children may just concentrate on their breathing.

Contacts

Should you have further questions about your procedure, you could contact the dermatology nurses on 01223 217391.