Your specialist will explain to you why the skin lesion needs excision and the procedure involved. You may have to sign a consent form to indicate that you consent to the surgical procedure.
The most common type of excision is an elliptical excision. The ellipse is designed so that the resulting scar runs parallel with existing skin creases. This ensures that the scar is as narrow and short as possible.
The area to be excised is marked with a coloured pen. Local anaesthetic is then injected around the area to make it go completely numb. This often stings when it is being injected but the stinging sensation subsides within seconds. The specialist will then cut around and under the lesion with a scalpel or sharp scissors so that it is completely removed. The lesion is placed in formalin ready to go to the pathology laboratory. Here, a pathologist will examine the specimen and provide your doctor with a report a few days later.
There may be some bleeding in the area from where the lesion has been removed. The doctor may coagulate the blood vessels with a diathermy. This can make a hissing sound and a burning smell.
The edges of the ellipse will then be sewn together to make a thin suture line. There may be two layers of sutures (stitches) a layer underneath that is absorbable and a layer of sutures on the surface that may need to be removed in a few days. Occasionally special paper sutures, called Steristrips, are used to join the edges together, instead of sutures.
Before the Procedure
- Please inform the doctor or nurse if you have a pacemaker fitted.
- Your skin lesion will be biopsied or removed under a local anaesthetic. This means that you will not be asleep during the procedure and you will be able to go home afterwards. It is advisable not to drive immediately after your surgery unless it is essential. Where possible, bring a friend or relative who can drive you home, or accompany you home in a taxi or on public transport.
- It is not necessary to go without food before your operation. A light meal may prevent sickness or reduce any nausea during the procedure.
- There is a small chance of bleeding, infection and/or scar formation, as with any surgery. If you have particular concerns, please discuss them with your hospital doctor on the day of your operation, before it is carried out.
- Before the operation, please inform the doctor if you are on any medication or if there has been a change in your health since your last consultation. For example, if you have developed diabetes, have an artificial heart valve, are taking anticoagulants (tablets that thin the blood) or aspirin.
- Please inform the doctor if you are taking any over-the-counter medication on a regular basis, or are taking any alternative types of medication. Please bring an up-to-date list of all your medication.
After the Procedure
If you have stitches (sutures), you should:
- keep them clean and dry
- keep an eye on the wound (where the stitches are) for any increase in redness, swelling or pain
This will reduce your risk of developing an infection (see Signs of infection below).
Protect your stitches
You should resist the urge to scratch your stitches as, even though they are strong, you may damage them. If you have stitches, avoid contact sports, such as football or hockey, to give your wound the best possible chance to heal. You should also not go swimming until your wound has healed and your stitches have been removed.
Children with sutures shouldn’t play with water, mud, sand and paint. Playing with things like this could cause the wound area to get dirty or sore or cause an infection. Children may also be advised to avoid PE at school until their wound has healed.
Signs of infection
As well as protecting your stitches, watch out for the signs of infection such as:
- increased redness around the wound
- pus or bleeding from the wound
- the wound feeling warm
- an unpleasant smell from the wound
- increasing pain
- a high temperature (fever)
If you have any of the symptoms above, speak to your GP or call NHS Direct on 111 for advice.
You will be told if you need to return to your GP or a nurse to have your stitches removed. For example, some stitches are made of dissolvable (absorbable) material and will disappear on their own.
If you have a dressing over your stitches, avoid getting it wet. Some dressings are waterproof, so you could wet your dressing lightly, for example, with the spray from a shower. However, you shouldn’t submerge your dressing under water. If you’re not sure whether your dressing is waterproof, then avoid getting it wet altogether.
Do not remove the dressing unless advised to do so by a healthcare professional.
Can I get my stitches (sutures) wet in the bath or shower?
- Try to keep your stitches (sutures) dry for at least the first 48 hours. After this it may depend on:
- what type of wound and dressing you have
- what advice you’ve been given by the specialist
In general, after 48 hours, surgical wounds can get wet without increasing the risk of infection. However, any skin graft dressings should remain dry until they have been removed. Further advice can be found in the skin graft advice sheet.