What You Should Know About Skin Surgery
You have a growth which we are going to remove because it irritates you
or because the doctor cannot be sure it is not a skin cancer. The most important thing to
do before your surgery is to avoid aspirin and alcohol (beer, wine, etc.) because these
drugs make your blood thin. When you arrive, we will first numb the area with Xylocaine.
This involves inserting a small needle into the area to be removed and then injecting the
medication. The medicine stings when it is injected and this is usually the worst part of
the whole procedure. After the Xylocaine is injected, the doctor will wait fifteen to
twenty minutes before starting. This allows the area to numb and also reduces bleeding.
The doctor will then remove the growth. This will be done by cutting it out with a
scalpel. You should not feel any pain when the doctor is cutting. If you do, tell him
right away and he will inject more Xylocaine. The doctor will cut an oval of skin around
the growth. This leaves a longer scar, but avoids the formation of "dog ears"
which are bunches of skin or folds of skin left over when a growth is cut out in a
circular fashion.
Figure 1 - Cutting the growth out in a circular fashion leaves a shorter scar but one will
have ugly "dogs ears." An oval excision makes a longer scar but will not cause
"dog ears."
The tissue removed will then be sent to a pathologist. The pathologist will look at the
edges to make sure the growth is all out and will also make sure there is no cancer in the
removed tissue. If the pathologist finds cancer in the removed skin, the doctor will have
to go back one week later and remove more tissue.
All surgery has risks. The risks of complications are low for skin surgery. When surgery
is performed on certain areas of the face, swelling can occur, especially around the eyes.
Sometimes the eyes can nearly swell shut. Typically this edema or swelling is worse in the
morning and improves as the day goes on. Most of the swelling will resolve in one week. If
your concerned about the swelling or have fever with swelling, call your doctor.
Most patients will have numbness in the area for six months, but this can last up to two
years or longer. The risk of infection is low, but studies show that no matter how clean
the surgery is, some wounds will get infected. If your wound gets infected, the doctor
will put you on an antibiotic for one week. The scar will not heal as well if your wound
becomes infected. It is very important that you follow the wound care instructions given
to you at the end of surgery. Sometimes a blood clot will form under the skin. If this
occurs you will have a hard lump in the area for six months or longer until your body
absorbs it. A blood clot is not dangerous, but it can be a real nuisance until it goes
away.
All patients will have a scar. There is no way to remove a skin growth without leaving a
scar. Often the scar can be hidden in your natural skin folds. You need to be patient,
because the scar will not have its final appearance for six to twelve months after the
surgery. If the scar has redness after one month or if it starts to elevate above the
skin, you need to schedule an appointment right away. This could be a sign that a thick
scar or keloid is forming. If the doctor sees a keloid or hypertrophic scar forming, he
can often stop or reverse it. This can be done by injecting it or by prescribing a
medication to put on it. Most scars on the back, thighs, shoulders, neck and upper arms
get wide, often an inch or more in width. There is nothing at this time that can prevent
wide scars from forming in these areas.
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