Dermatology (Skin conditions)

Information Prior to having a Skin Biopsy or Skin Excision

Contact: 0191 282 4485 - Dermatology Department

You have been given an appointment to attend the Dermatology Surgical Unit where you will have a surgical procedure to investigate or treat your skin condition.

This information aims to explain some aspects of your surgical treatment. If you require further information, please ask staff or telephone 0191 282 4485

If the appearance of your lesion changes, or you have have any concerns before the date of your surgery, please contact your consultant's secretary (or the Waiting List Office if you are unsure who your consultant is) and they will be able to give you further advice.  It may be necessary for you to be seen again in clinic.

Location
Your surgical treatment will be done in the Dermatology Surgical Unit, which is situated on the ground floor of the Victoria Wing of the RVI. Please
report to the surgical unit immediately upon arrival.

Transport
There is a multi-storey car park for patients’ use in the grounds of the RVI, which is situated off Queen Victoria Road. Patients may be dropped off and picked up by car at the main entrance to the Victoria Wing at the RVI. Public transport (metro and buses) to the Haymarket which is only a short walk from the hospital. If you require an ambulance to bring you for your appointment you should contact your GP, who will be able to book an ambulance for you. Please arrange this a week in advance.

Eating and Drinking
You may eat and drink as usual prior to your operation.

Clothing
On arrival at the Dermatology Surgical Unit you may be asked to replace some of your clothing with a theatre gown. This will give the doctor or nurse better access to the area being operated on and will protect your own clothing.

Waiting Area
There is a waiting area available for patients on the Dermatology Surgical Unit. For relatives or friends of patients there is a small waiting area on the corridor adjacent to the theatre. We would ask all patients to bring only one relative or friend with them due to the limited space available. We have no facilities for accompanying children.

Appointment
Every patient is given an appointment time. Try to arrive on time, but not more than 10/15 minutes early. Every effort is made to see patients at the appointment time, but inevitably delays sometimes occur. Please bring a book or newspaper with you to help you pass the time.

Valuables
Please do not bring any valuables with you when you attend as the Trust cannot be held responsible for any loss which might occur. Please keep jewellery to a minimum.

Medication
Please bring a list of any current medication with you when you attend and tell the nurse on the reception desk if you have a pacemaker or a heart problem that require antibiotic cover for dental or similar procedures. We also need to know if you are diabetic or are unable to stand or walk without a lot of assistance. A hoist can be arranged for lifting purposes. If you require an Interpreter because of language difficulties please inform us. If you are having treatment to your face please remove make-up before you attend.

Follow-up Appointments
Follow-up appointments will be made before you leave the surgical unit. You will also be given further information regarding your wound care. Most patients will be able to leave the surgical unit immediately after their operation.

Driving
You will not be able to drive home if your treatment has involved your hands, feet, or if a dressing has been applied over an eye. If in doubt please seek advice from the doctor or nurse.

Cancellation or Re-arrangement of Appointment
If you are unable to attend or no longer need your appointment then please telephone 0191 282 4485 and let us know. This will enable another patient to take your place.

What is being done and why?
A skin biopsy is removal of a small piece of skin. This is done to confirm or establish a diagnosis so that further treatment can be planned or reassurance given. Skin excision is removal of a skin lump in order to either make a diagnosis or as part of treatment. The reason for your surgery will have been explained to you by the doctor or nurse.

Will I feel anything?
A local anaesthetic will be used. This means that you will have an injection in to the skin at the site of the biopsy before surgery. The injection will sting initially. However once the anaesthetic has taken effect your skin will be numb, although you may feel pulling or tugging. You will be awake throughout the procedure and will not be sedated or feel drowsy.

How long will it take?
Usually between 20-40 minutes. Some complex or larger procedures may take longer.

Who will do the procedure?
Most skin biopsies or excisions are done by a dermatologist or a dermatologist in training. Some smaller procedures will be done by a trained dermatology nurse.

What happens to the piece of skin that has been removed?
In most cases, the piece of skin removed will be analysed in the laboratory and looked at down the microscope. The process usually takes 1-2 weeks. Your doctor will then know whether the diagnosis has been confirmed or if the other possibilities have to be considered.

Occasionally further biopsies or surgery will be required.

At the end of the procedure pieces of skin may be left over; these are normally incinerated. These sometimes can be used for research into skin disease.
Similarly in some patients with skin tumours tiny pieces of tumours can be used for research purposes. The doctor doing the surgery may ask if you would be willing to allow any such pieces of skin to be used for research. Whether you agree or not will not affect your treatment in any way.

What happens after the biopsy?
In order to take the biopsy the skin will be cut or scraped. This will leave a wound. In some instances the wound will be stitched (sutured), on others it will be left as an open wound rather like a graze.

If stitches are used these will have to be removed 1-2 weeks later. You must be sure to be available for this to be done (e.g. not on holiday) before the procedure is organised. After stitch removal the wound is weak and will have to be treated carefully to prevent the wound breaking down.

In most cases a dressing will be required and this will have to be kept clean and dry. In some instances the dressing can be removed after a few days and the wound washed in the shower. The nurse or doctor will advise.

If the wound is on your lower leg you should be prepared after the procedure to rest with you leg elevated for the first 24 hours. You may be advised not to walk more than 400 metres within this time.

What are the risks of having a skip biopsy or excision?
When the local anaesthetic wears off (around 1-2 hours later) the wound will be painful and there may be some limitation of movement. It depends on where the wound is and how big it is, whether this discomfort will be significant or just a minor hindrance. Paracetamol tablets may be required for the pain. The discomfort should start to reduce after 3-4 days. If the pain gets worse after four days it usually means there is an infection and you should seek medical help.

Details on how to contact the department will be given to you after the procedure.

The skin around the wound will be swollen. This normally lasts for 3-4 days depending on the nature, size and site of the procedure. Bruising is also common and lasts 5-7 days.

Because the skin has been cut there could be a risk of infection of the wound. This is particularly the case if a dressing is applied and this is allowed to get wet. If the dressing is soiled or becomes wet it will need to be removed. Wet dressings make infections more likely.

As with any cut or skin injury there is always a risk of bleeding. For this reason a dressing is usually required and you will be instructed how to deal with such an eventuality. It will be necessary to restrict your activity in the days following the procedure. Vigorous exercise may stretch the wound causing it to bleed or burst. Seek medical advice if this happens.

You will certainly have a scar following the procedure although it may not be very noticeable. Each case is different and depends on a number of factors including the nature of the procedure, the site and your age. If there is a danger of structures such as nerves or tear ducts being cut or injured during the procedure these possibilities will be discussed with you by the doctor doing the procedure. 

Allergic reactions to dressing, rubber gloves, skin antiseptic solutions, local anaesthetics are very unusual. Make sure you tell the doctor if you know you are allergic to any of these items.

How will I hear about the outcome of this procedure?
The doctor will either write to you and your GP with the results when they become available or make a follow-up appointment for you in the clinic to discuss the results. It frequently takes 3 weeks for the skin specimen to be examined and a report issued by the laboratory so expect a delay.

Any other questions?
If you have any other questions please do not hesitate to speak to the nurse or doctor before leaving the department.

Website information: www.dermnetnz.org - This New Zealand based web site provides well written patient information on a range of dermatological subjects.

Smoking cigarettes reduces blood flow to the skin so the wound may not heal properly leaving a worse scar than usually expected. Smokers are strongly advised to stop smoking two weeks before the operation and for at least two weeks after the operation. You can get help to stop smoking from your GP or smoking cessation service.


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