SURGICAL SKIN TREATMENTS

Minor skin surgery refers to a simple surgical procedure carried out under local anaesthetic, used to remove non-cancerous skin lesions.

The procedure is carried out in the clinic as a ‘day case procedure’, meaning that no prolonged or overnight stays are required.

Depending on the lesions to be treated, this may involve shaving, snipping, excising or curetting (scraping) the lesions away.

The goal of treatment is to remove the lesion in order to improve the appearance of the area or in order to reduce symptoms such as discomfort, trauma, irritation or inflammation.

These procedures are quick (usually ranging between 15-45 minutes), well-tolerated and safe, with a prompt return to normal activities of daily living.

Click here to find out more about how various skin lesions can be treated and what the different types of skin surgery involve.

Minor surgical procedures can be used to treat a wide range of benign skin lesions, including:

• Skin tags (acrochordons)

• Seborrhoeic keratoses (warty, pigmented lesions)

• Epidermoid cysts

• Lipomas (soft, fatty lumps under the skin)

• Moles (that are non-suspicious and cosmetically bothersome)

• Dermatofibromas (firm nodules caused by minor skin trauma)

• Cherry angiomas (small, red blood vessel growths)

• Milia (small, white cysts often seen on the face)

• Benign viral warts

• Histology sampling, where the lesion is sent for lab analysis

All lesions will be assessed during your consultation to determine if minor surgery is appropriate and safe.

Where this is a high index of suspicion for potentially cancerous lesions we would recommend you visit your GP for prompt NHS treatment and removal.

We understand that our patients can be very busy with their daily lives and therefore it is ideal for most to be able to combine their consultation and surgery during the same visit.

Therefore, although we do offer the option to proceed with surgery on the same day (known as a ‘See and Treat’ appointment), we will only do so if you are certain you would like to proceed and if it is safe to proceed on the same day.

If you would prefer to think through all the treatment options first and make provisions for potential downtime, restrictions in exercise etc, then it is best for us to carry our your consultation first, then plan a separate visit for your treatment.

As an ethical medical clinic, we never want you to feel pressured to undergo treatment on the same day, therefore rest assured that your consultation fee is fully redeemable against your treatment, even if you decide to delay your treatment by several weeks or months.

As we always advise patients in the clinic, never feel rushed to commit to an elective, non-emergency procedure and take all the time you need to make that decision.

If we feel like it is not medically appropriate to proceed we will advise you of this – as a medical clinic your safety as our patient will always be our main priority.

This may be due to:

• The presence of other conditions or co-morbidities that make surgery unsafe or might require us to delay treatment (e.g. use of anticoagulant or antiplatelet medications)

• Active infection at the operative site (e.g. if you attend with an infected cyst we will recommend a course of antibiotics in the first instance, unless urgent drainage is required)

• The presence of a Cardiac Pacemaker or Implantable Cardiac Defibrillator

• The presence of severe allergies which might make it unsafe to proceed with treatment in the community

• A strong history of abnormal scarring

• If your lesion requires further investigation such as a scan to determine if it is safe to remove in a clinic setting (this is especially important if we are dealing with large lipomas or cysts of an uncertain nature)

• If you present with a lesion whose appearance and history is suspicious of a skin cancer or an abnormal growth. Although we want to support you in your treatment and we fully understand the frustration of long NHS waiting lists and the worry of leaving things untreated, as clinicians who have extensive experience in treating cancerous lesions in the NHS setting, we must advise that it is the most appropriate and safe setting to have any suspected or confirmed skin cancer treated, investigated and followed up.

Dr. Jenny will be happy to prepare a referral letter which you can take to your GP to help expedite a hospital referral.

• If based on our clinical experience we feel that the surgery would carry more risks than benefits

• If you aren’t 100% sure you want to proceed with surgery: If in doubt we will always advise that you take the time you need to think things through and then return for your procedure when the timing is right.

Following your consultation, you will be consented for your procedure.

The lesions to be removed are photographed for your medical records.

Depending on the lesion being treated, we may need to first mark out the lesion and plan the incision using a surgical marker.

The area is then numbed using a numbing injection: The local anaesthetic injection does sting for a few seconds but rest assured that this uncomfortable sensation resolved very quickly and soon you will feel the numbness setting in.

As local anaesthetic specifically targets the sensation of sharpness and pain, please don’t be alarmed if you can still feel sensations such as pressure, gentle prodding or movement as this is perfectly normal. We will always ensure that you are completely pain-free before commencing!

The operative area is then cleansed with an antiseptic solution and the surrounding area is covered with a sterile sheet or drape to ensure that infection risk is minimised.

The lesion is then surgically removed using the appropriate technique and depending on the procedure we may then go on to stitch and/or dress the area.

Most procedures take between 15–45 minutes and you can return to normal activities shortly afterwards.

This is indeed possible but it will all depend on the type, size and number of lesions due to be treated and also on the type of excision required.

For example it may be perfectly safe to snip away 10 small skin tags in 1 sitting, whereas if you are having an excisional procedure involving sutures or removal of larger lesions, then it may only be suitable to treat 1 or 2 in one sitting.

This can be discussed during your consultation and treatment planning. Although it is tempting to treat multiple areas in one go, it is important that we proceed with caution and your safety in mind.

We take all possible measures before, during and after your procedure to help minimise surgical risks, however with all surgical procedures, however big or small, we have to discuss the risks associated with the surgery and recovery process.

This ensures that you are fully prepared before your surgery and also means you have all the information regarding what to look out for post-operatively and to ensure your recovery is as safe and smooth as possible.

This is what we discussing at length during your consultation and consent process.

Click here for an in-depth overview of possible surgical risks.

At Dr. Jenny Clinic, we are committed to providing safe, ethical and medically responsible skin surgery. For this reason, we will routinely send all of your moles and pigmented lesions for histological testing (lab analysis). We will also send all dermatofibromas as well as medium or large lipomas for histological testing.

What is histology and why is it important?

Histology is the microscopic examination of tissue by a pathologist to confirm the exact nature of the lesion. Even if a mole or lesion appears benign during your clinical examination, histology is the only way to confirm this with certainty.

This allows us to:

• Ensure nothing has been missed

• Provide a clear medical diagnosis

• Offer you full peace of mind

When is histology included?

We include the cost of histology as standard for all of the following procedures:

• Mole excision or shave excision

• Removal of pigmented lesions such as shaved seborrhoeic keratoses or unusual freckles

• Removal of dermatofibromas

• Removal of large or medium lipomas

• When removing what initially appears to be a typical lesion but our intra-operative findings raise suspicion

Rest assured, that there is no additional fee for histology in these cases: Your quoted treatment price includes the cost of safe surgical removal and professional laboratory analysis.

Once the results are available, Dr. Jenny will review them and inform you of the outcome and advise on whether any further action is needed.

Optional Histology for Other Lesions

For the removal of non-pigmented or clinically typical lesions such as:

• Cysts

• Lipomas

• Skin tags

• Warts

• Milia

Histology is not routinely required, but can be added as an optional extra for your reassurance.

If you’d like us to send any of these for lab testing, we will happily do so at a supplementary charge of £120 per sample.

We will always advise you during your consultation if histology is clinically recommended or optional for your specific case.

We understand that it can be daunting to undergo a surgical procedure and that having a friend or relative present can help alleviate any potential anxiety, what we usually recommend is that it is best to have your friend/relative with you during the consultation and examination part of your visit – this way they can help with any questions you might have and they can also help support you with your aftercare.

However for the surgical procedure itself, it is advisable that your friend or relative wait for you outside in the waiting area, and then we can call them in as soon as the procedure is finished.

This is because, often times unexpectedly, the person accompanying you may start to feel unwell or dizzy if they are observing your surgery and our focus needs to be on operating on you safely, therefore we won’t be able to safely tend to a second patient if we are treating you and they start to feel unwell.

Please also be advised that we can’t allow children in during your consultation and treatment, so do ensure you have made childcare arrangements prior to attending for your appointment.

Minor surgery itself as well as the local anaesthetic we use does not pose a threat to you or your baby, both during and after pregnancy.

However, it is important that you let us know before proceeding so that we can give you the best advice possible.

Often, for non-urgent skin lesions, it may be best to wait until after childbirth so that you don’t have to deal with potential surgical risks such as infection, healing problems or scarring during your pregnancy and post-partum period.

Provided you are feeling well in yourself, with no dizziness then you will be able to leave shortly after your treatment.

Once the procedure is complete, the area will be covered by a dressing such as a plaster or skin tape.

In areas where we are unable to place a dressing e.g. the scalp, other hair-bearing areas, the lips or eyelids, instead we will use a thick wound ointment straight after surgery such as a Vaseline/paraffin or antibacterial ointment.

Depending on your procedure, you will be asked to keep the wound covered and dry for 1-2 days.

Thereafter you can remove the plaster if there is one and wash the skin as normal with soapy water, provided you aren’t very forceful in rubbing the area where there is a scab or stitches.

For certain wounds we will advise that it is safe to then continue without a dressing, but to apply Vaseline to the treatment area 2-3 times a day to protect the wound.

Continue doing so until either the scab drops off or until the stitches are removed or fall off.

If you require any further wound dressings or if we advise techniques such as scar taping for the post-operative period, this will be discussed during your consultation.

If you have had removable sutures to close the wound, we will arrange a post-operative review appointment in order to remove these for you and check your healing.

Between 2-4 weeks post surgery we will advise that you commence with scar massage twice a day to help your scar remodel and mature as well as possible.

Scar massage can be carried out with any simple moisturiser, skin oil or Vaseline that agrees with your skin.

If you have a high risk for hypertrophic or keloid scarring then we advise that you also opt for the application of a silicone-containing gel or sheet.

Scar massage is beneficial to healing scars for up to 12-18 months after scar formation so we greatly encourage you to incorporate this as soon as possible in your healing journey.

It is essential that you protect fresh scars from UV radiation as this may increase inflammation, irritation and redness.

We encourage all of our patients to book in for a complimentary review appointment if they have any concerns or queries about their healing, or if you just want us to check in and confirm that your healing is progressing as it should.