DC11 Day Case - Removing Benign Skin Lesions (under Local Anaesthetic)

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1 DC11 Day Case - Removing Benign Skin Lesions (under Local Anaesthetic) What are skin lesions? What is a mole? Skin lesions are found on or just below the skin. Examples of skin lesions are epidermoid cysts (also called epidermal inclusion cysts or sebaceous cysts), lipomata (plural of lipoma), skin tags and moles. These are usually not life-threatening but your surgeon can remove your skin lesion if you want. You may simply leave the skin lesion alone if your surgeon is certain it is benign. A skin lesion can almost always be removed under local anaesthetic. The information about local anaesthetic is at the end of this document. It is your decision to go ahead with the operation or not. This document will give you information about the benefits and risks to help you make an informed decision. If you have any questions that this document does not answer, you should ask your surgeon or any member of the healthcare team. What is an epidermoid cyst? An epidermoid cyst is a lump in the skin where a cyst fills with a waxy whitish substance. It usually has a central pore which opens onto the skin. What is a lipoma? A lipoma is simply a lump of fatty tissue in the layer of fat underneath the skin. The skin over it is completely normal and is not attached to the lipoma underneath. A lipoma can vary in size and some may grow to over ten centimetres (four inches). There is often only one of them but some people have several at the same time. What is a skin tag? A skin tag is a small lump hanging from the skin. A mole is a coloured lesion, which may be present at birth or develop later in life. Moles that change suddenly may be turning malignant (cancerous) and your doctor may recommend that your mole is removed to make sure it does not change into a cancer. Are there any alternatives to surgery? Surgery is the only reliable way to remove skin lesions but you may simply leave them alone. What will happen if I decide not to have the operation? Epidermoid cysts can be left alone and often cause no problems at all. Some may grow in size. Occasionally the contents of epidermoid cysts leak out or they can become infected, needing antibiotics or surgery. Lipomata tend to grow in size if they are left alone. As they get larger they appear more obvious and can interfere with clothing. Occasionally lipomata on the inside of the upper arm or thigh may rub during movement and cause irritation or pain. What does the operation involve? The healthcare team will carry out a number of checks to make sure you have the operation you came in for. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having. The operation usually takes between fifteen and twenty five minutes. Your surgeon will only begin the operation when both of you are satisfied that the local anaesthetic is working. Copyright 2009 DC11 Page 1 of 6

2 When removing an epidermoid cyst, your surgeon will try to remove it whole as this makes sure that none of the cyst wall is left behind and prevents it from returning. Your surgeon will make an elliptical cut over the cyst (see figure 1) and will then cut out the cyst. Your surgeon may be able to safely remove the cyst using a smaller cut. They will close the cut with stitches which usually heals to leave a small straight scar. The stitches may be dissolvable. If not, they are usually left for five to seven days, but this will depend on your operation. They can be removed at your GP s surgery after this time. Skin lesion Figure 1 Elliptical cut Epidermoid cyst and typical cut made to remove it To remove a lipoma, your surgeon will make a straight cut in the skin directly over it. The lipoma is freed up from the tissues around it and removed. They will then close the cut with stitches which can be removed at your GP s surgery in about five days, depending on your operation. A skin tag can simply be numbed with local anaesthetic and then removed. You will often not need a stitch. When removing a mole, your surgeon will cut all the way around it using an elliptical cut. They will close the cut with stitches which usually heals to leave a small straight scar. What should I do about my medication? You should make sure your surgeon knows the medication you are on and follow their advice. You may need to stop taking warfarin or clopidogrel before your operation. If you are a diabetic, it is important that your diabetes is controlled around the time of your operation. Follow your surgeon s advice about when to take your medication. If you are on beta-blockers to control your blood pressure, you should continue to take your medication as normal. What complications can happen? The healthcare team will try to make your operation as safe as possible. However, complications can happen. Some of these can be serious. You should ask your doctor if there is anything you do not understand. Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. The complications fall into three categories. 1 Complications of anaesthesia 2 General complications of any operation 3 Specific complications of this operation 1 Complications of anaesthesia Please read the information about local anaesthetic at the end of this document. 2 General complications of any operation Pain, which happens with every operation. The local anaesthetic will start to wear off after a couple of hours. After this time you may feel some pain. You may need simple painkillers such as paracetamol or ibuprofen. Bleeding during or after surgery. This is usually little but may cause bruising or temporary swelling under the skin. Copyright 2009 DC11 Page 2 of 6

3 Infection of the surgical site (wound). This is unusual. To reduce the risk of infection it is important to keep warm around the time of your operation. Let a member of the healthcare team know if you feel cold. In the week before your operation, you should not shave the area where a cut is likely to be made. Try to have a bath or shower either the day before or on the day of your operation. After your operation, you should let your surgeon know if you get a temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but you may occasionally need another operation. Unsightly scarring of the skin. Wound breakdown, if the skin fails to heal. This is usually treated with dressings that allow the wound to heal without needing more stitches. 3 Specific complications of this operation A lipoma or an epidermoid cyst can come back, which may need a further operation. A larger operation may be needed. If a lesion was removed and was found to be a cancer, an operation will be needed to make sure it is completely removed. How soon will I recover? In hospital After the operation you will be transferred to the recovery area. After a short while you will be able to go home. A responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. You should be near a telephone in case of an emergency. At home You should not drive, operate machinery (this includes cooking) or do any potentially dangerous activities for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination. If you had sedation, you should also not sign legal documents or drink alcohol for at least 24 hours. If you are worried about anything once you are at home, contact a member of the healthcare team on the phone number they give you. They should be able to reassure you or arrange for you to have a check-up. Returning to normal activities You should be able to return to work the following day unless your work will put a strain on the stitches. It is unusual for these procedures to restrict any daily activities you carry out. Lifestyle changes If you smoke, try to stop smoking now. Stopping smoking will improve your long-term health. For help and advice on stopping smoking, go to You have a higher chance of developing complications if you are overweight. For advice on maintaining a healthy weight, go to Exercise Regular exercise can reduce the risk of heart disease and other medical conditions, improve how your lungs work, boost your immune system, help you to control your weight and improve your mood. Exercise should improve your long-term health. For information on how exercise can help you, go to Before you start exercising, you should ask a member of the healthcare team or your GP for advice. Summary Skin lesions are common and can be treated by surgery. Surgery is usually safe and effective. However, complications can happen. You need to know about them to help you make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early. Copyright 2009 DC11 Page 3 of 6

4 Local Anaesthetic What is a local anaesthetic? A local anaesthetic is a drug that is injected into the tissues to make them numb. Your anaesthetic will be given to you either by your surgeon or by your anaesthetist (doctor trained in anaesthesia). A local anaesthetic has been recommended for your operation. However, it is your decision to go ahead with a local anaesthetic or not. This document will give you information about the benefits and risks to help you make an informed decision. If you have any questions that this document does not answer, you should ask your surgeon or anaesthetist, or any member of the healthcare team. How does a local anaesthetic work? Local anaesthetics temporarily stop nerves working so that you do not feel pain. The simplest form of local anaesthesia is to inject the drug just around the area where the operation is going to take place. This tends to sting or burn for a few seconds and then the area goes numb. The feeling of pain goes away much sooner than the feeling of touch, so do not be alarmed if you can still feel pressure or movement. It is possible to numb all the nerves to an arm or a leg (called a regional block). The procedure will not start until you and your surgeon are both satisfied that the area is numb to pain. Although the starting area is numb, the operation may reach areas that have not been numbed. If this happens, your surgeon will give you some more local anaesthetic until those areas are numb to pain. Local anaesthetics generally work for a few hours, depending on the type of drug and dose used. After this time the area should go back to normal. Are there any alternatives to a local anaesthetic? If you are concerned about being awake during the operation, it may be possible for it to be performed under a general anaesthetic. However, there are complications associated with a general anaesthetic. Other anaesthetic procedures may be possible such as an epidural or regional block, although these also use local anaesthetic drugs. Sometimes it may be possible to use a sedative as well as a local anaesthetic. What complications can happen? The healthcare team will try to make your anaesthesia as safe as possible. However, complications can happen. Some of these can be serious and can even cause death. The possible complications of a local anaesthetic are listed below. Any numbers which relate to risk are from studies of people who have had a local anaesthetic. Your doctor may be able to tell you if a risk of a complication is higher or lower for you. Not enough pain relief, which is usually corrected by giving more local anaesthetic. Occasionally other forms of drugs or anaesthetic have to be given as well. Let your surgeon know if you are in pain. Allergic reaction to local anaesthetics. This is unusual. Many people have been told, or think, they are allergic to local anaesthetic given at the dentist. This is rarely the case, but you should let the person giving your local anaesthetic know about any problems you have had in the past. Bleeding, if the needle used to inject the local anaesthetic strikes a blood vessel. This usually results in a small bruise that will not cause problems. Nerve damage (risk: 1 in 5,000). Occasionally the local anaesthetic has a longer effect than expected (up to 48 hours) but this usually settles down on its own. Copyright 2009 DC11 Page 4 of 6

5 Absorption into the bloodstream, if the local anaesthetic is accidentally injected into the bloodstream or if it is absorbed into the bloodstream more quickly than usual. This is rare but can cause various problems temporarily affecting the heart and brain, which can be serious. The dose of local anaesthetic is always limited to reduce this risk. You should discuss these possible complications with your surgeon or anaesthetist if there is anything you do not understand. Summary A local anaesthetic can be used for most people, giving a safe and effective form of pain relief both during and after your operation. However, complications can happen. You need to know about them to help you make an informed decision about your anaesthetic. Knowing about them will also help to detect and treat any problems early. Local information You can get information locally from Customer Services on (answerphone , fax , textphone ). Tell us how useful you found this document at This document is intended for information purposes only and should not replace advice that your relevant health professional would give you. DC11 Issued July 2010 Expires end of December Further information NHS smoking helpline on and at for advice on maintaining a healthy weight for information on how exercise can help you for support and information you can trust Association of Anaesthetists of Great Britain and Ireland at Royal College of Anaesthetists at Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland NHS Direct on ( textphone) Acknowledgements Author: Mr Ayan Banerjea MRCS, Mr Simon Parsons DM FRCS (Gen. Surg.) and Dr Iain Moppett DM MRCP FRCA Copyright 2009 DC11 Page 5 of 6

6 Copyright 2009 DC11 Page 6 of 6

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