Pre-operative advice for patients who are due to have skin surgery

Who is the leaflet for? What is its aim?

One of the doctors or nurses in the dermatology department will have explained to you that you need to have a small operation to remove a skin lesion or to obtain a sample of skin. This leaflet explains the operation and answers some frequently asked questions.

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

What should I do before the operation?

If you are pregnant, please contact the clinic for advice (01223 216091).

Please ensure you inform us of your medications and any drug allergies.

If you are taking warfarin please arrange for an INR blood test one to five days before your operation. INR results are given as a number (for example 2.1) and the condition you are taking it for has a required therapeutic range that your doctor tries to keep you within (for example, 2.0-3.0 but sometimes higher). We prefer for your INR to be 3 or lower before we operate. However you should not let your INR drop below your therapeutic range as this puts your health at risk. Please do not adjust or stop taking your warfarin without discussing it with your prescribing doctor. We simply want to avoid a very high INR during surgery but we do not require for it to be below the required therapeutic range. If the INR is very high, we may need to postpone the operation until another date, so please phone 01223 216091 if your INR is above 3.

If you are taking aspirin or clopidogrel prescribed regularly for your heart or circulation; or an oral anticoagulant (such as rivaroxaban / dabigatran) you may or may not be advised to stop the tablets. If the dermatologist asked you to stop any of these medications prior to the procedure, please discuss this with your GP or the doctor that prescribed these medications to ensure that coming off them for a few days will not put your health at risk.

Please do not stop any medications before discussing this with a doctor.

Please avoid non-steroidal anti-inflammatory drugs (such as ibuprofen ), aspirin (unless prescribed - see note above) and all aspirin-containing medicines, such as some cold and flu remedies, for seven days prior to and for two days after your surgery.

Certain herbal remedies also thin your blood so please stop these two weeks prior to surgery. If you have a pacemaker or defibrillator you must inform us of the type as we may need to check this before the operation. Please phone 01223 216091 to inform the surgical co-ordinator.

What should I do on the day of the operation? What should I bring with me?

Please bring a list of your current medications with you on the day of your operation.

On the day of surgery please take any regular medications (unless you have been told otherwise) and eat a normal breakfast or lunch. We suggest you wear loose fitting, comfortable clothes. You may wish to bring a friend or relative accompany you, although they are not routinely permitted to be in the operating theatre during the operation (please check with clinic 7 during COVID pandemic as visitors may not be allowed in hospital). You may also wish to bring a magazine or book to read as operations sometimes take longer than anticipated, resulting in delays.

All operations will take place in one of the theatres in Clinic 7, Level 3, Addenbrooke’s Hospital. Please report to the clinic reception desk when you arrive.

If you have a pacemaker or defibrillator you must inform the doctor before the operation starts.

Unfortunately staff in the clinic are unable to take care of any children while you have treatment. We suggest that either you make alternative arrangements for childcare or someone else comes to the unit with you.

What kind of operation am I having?

The type of operation will be discussed with you in clinic, and details of the operations are given below.

Before the operation we will ask you to sign a consent form.

All operations will be carried out under local anaesthetic so that you will be awake throughout and able to talk to us. The local anaesthetic will numb the area being operated on so you should feel no pain.

Types of operation:

Punch biopsy (approximately 20 minutes)

• A three / four / six mm circle of skin is removed from the rash or lesion.
• The wound is sutured with a couple of stitches or allowed to heal over.

Incisional biopsy (approximately 20 minutes)

• A small ellipse (oval) of skin is removed from part of the rash or lesion.
• The wound is sutured with a few stitches (usually no more than five).

Curettage (scraping) or shave biopsy (approximately 20 minutes)

• The lesion is scraped off or shaved off using a very sharp blade, leaving a graze or a small depression in the skin.
• The bleeding is stopped using an electric cautery machine. This procedure does not require stitches.

Excision of skin lesion (approximately 40 minutes)

• A whole skin lesion is removed with a margin of normal skin around the edge.
• The bleeding is stopped using an electric cautery machine.
• There will usually be several stitches both above and below the skin surface.

Local anaesthesia is usually effective for about two hours. The wound often feels tender after this time. You may take paracetamol tablets for pain relief if necessary, unless you are advised otherwise.

What should I do or not do after the operation? Can I drive home afterwards?

Although some people are able to drive themselves home after surgery, we suggest that the majority of patients have a companion to escort them home. Patients should not drive after surgery to the central face area. Patients who are having an excision should not cycle after their appointment.

Depending on the procedure performed you may have a number of stitches and a dressing. You will need to keep the wound and dressing dry for 48 hours. This may make it difficult to have a bath or a shower during this time.

Any stitches will usually require removal either by the nurse in your GP’s practice or in the hospital clinic between five and 14 days after the procedure. Please let us know prior to your operation if you anticipate that this may be a problem.

You should avoid activities such as cycling, swimming, other strenuous exercise, bending, straining or lifting heavy objects for 14 days following the procedure.

Smoking has been shown to have an adverse effect on wound healing after surgery. We would therefore recommend that you do not smoke for one week after your operation.

Does the operation carry any risks?

Bleeding:

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

Infection:

Rarely a wound can become infected, and this will show up as increased pain, swelling and redness of the wound after a few days. If you are concerned that the wound may have become infected, please contact your GP or this department for advice.

Scarring:

Any form of surgery will leave a scar. The length, type and width of the scar will depend on the type of wound closure performed. If the wound was closed using stitches, the stitch line is likely to be red initially but this redness usually fades over a period of weeks to months.

Contacts / further information

Should you have any questions about your procedure, please feel free to ask us when you attend for treatment or you may contact the surgery booking office on 01223 216091.