What is an excisional biopsy?
An excisional biopsy is a simple surgical procedure where an entire lump or entire area is removed from the skin. The sample is then taken for testing.
Why do I need this procedure?
There are a number of reasons to have skin excisional biopsy, such as:
- to remove a benign tumour or a skin cancer
- to improve the cosmetic appearance of an area on the skin
- to relieve symptoms (if a lesion is tender or prone to being knocked)
- to remove an inflamed or frequently infected cyst or lesion
Having skin surgery with histological analysis (looking at the sample under a microscope) will help to confirm your diagnosis and can also help alleviate any symptoms that you maybe having from particular skin lesions.
What are the risks of having skin surgery?
In general skin surgery is a safe procedure and recovery is usually quick within 1-2 weeks, depending on your procedure. However, every surgical procedure will carry some risks:
- Bleeding: this will be controlled at the time of the procedure, but as the anaesthetic wears off, rarely bleeding can occur. If this occurs, we recommend applying firm pressure with a towel or cloth for at least 15 minutes. If the bleeding does not stop, then you will need to seek medical attention. If within working hours we would be keen to see you at OneWelbeck to examine the wound.
- Infection: if your wound becomes increasingly red and painful then you may have developed an infection. Please inform your surgeon of this and take pictures of your wound if you are able to. Antibiotics will usually be prescribed to treat the infection. If you are diabetic or immunosuppressed then you have a higher risk of infection, please discuss this with your surgeon.
- Scarring: all surgical procedures will leave a scar. The scar will usually be hidden in the skin creases. Scars heal best when there is no tension on the wound, therefore internal dissolvable sutures (stiches) maybe used to reduce tension across the wound, which will dissolve over time. Scars that become lumpy or inflamed 1-2 weeks after surgery may need treatment.
- Swelling and bruising: even small procedures may result in significant swelling and bruising, especially around the eye. This will settle over time but if you are concerned please do contact your surgeon for advice.
- Pain: most procedures cause very little pain both during the operation and after. We need to know if your pain is increasing after the procedure, please contact your surgeon. We recommend using paracetamol for pain relief. Please avoid aspirin as this can cause bleeding.
What should I do before the procedure?
We want your procedure to be a pleasant experience, therefore preplanning is essential. Below are some issues that may help in planning your procedure.
Driving: after the procedure you may not be safe or able to drive, therefore please arrange for a driver, unless we have specifically informed you that you can drive.
Medications: certain drugs may affect your surgery. Please provide your surgeon with an up do date list of drugs that you are prescribed and include over the counter medications such as vitamins that you may buy yourself. For example garlic tablets can cause increased bleeding and we would recommend stopping these at least one week before surgery.
Allergies: Please let your surgeon know any allergies that you may have. Please bring documentation of this to your appointment.
Pacemaker or defibrillator: if you have any implanted devices, this may affect what equipment we can use, but should not prevent your surgery. Please discuss this with your cardiologist.
Holidays/special events: you may have a dressing and stitches that need to be removed, which may be difficult if you are going away within 2 weeks of your surgery. As there may be bruising, you may not look or feel your best for a special event. Unless your surgery is URGENT please reschedule the procedure by phoning us.
Sports/exercise: you should not swim, play sports (including golf), or exercise (including gardening) whilst the stitches are in place. Please plan ahead in terms of sports activities and discuss with your surgeon.
Smoking: this delays wound healing and therefore stopping smoking completely for at least a week prior to surgery and at least a few weeks after, will help your wound heal with less chance of complication.
Pain relief: ensure that you have an adequate supply of paracetamol at home for when you return. Taking paracetamol an hour before the procedure can help with the pain of the local anaesthetic injection during the procedure.
What does an excisional biopsy appointment involve?
Your procedure will be undertaken by an expert in their field, if you have not had skin surgery before, below is summary of the steps that you will experience on the day.
Consent for surgery: you will be asked to sign a consent form unless you are under 16 years old when a parent or guardian must sign. This form indicates that you are aware of the procedure to be carried out. You will be given a copy of your signed consent and must ask any questions you have during the consent process.
Undressing: you will be asked to remove enough clothing so that we can clearly see the part of your body that needs a procedure. It would be helpful to wear loose casual clothing on the day.
Marking: the area of skin to be removed will often be marked with ink. This is not permanent.
Operating couch: apart from exceptional circumstances such as breathlessness or immobility, you will be treated whilst lying down on an operating couch. This makes the operation easier and optimises the use of the operating light.
Local anaesthetic: Most minor operations need a local anaesthetic to numb the area, which will be injected just under the area to be treated. It causes a mild sting lasting 5-10 seconds. The operation will then be pain free. Please let us know if you feel any discomfort during the procedure, and we will top-up the anaesthetic. Your procedure should be painless once the anaesthetic has taken effect. It is common to feel pulling or pressure at the operating site during the procedure.
Stitches (sutures): at the end of your procedure the skin maybe closed with stitches that can be removed 1-2 weeks later, depending on the site. Sometimes dissolvable stiches are used and these will dissolve slowly over 2-4 weeks.
Strapping or bandaging: all stitched wounds will be well strapped up with special dressings. You will be advised at the end of the surgery on the necessary wound care. This information will be explained to you verbally and in writing.
Duration: depending on the complexity of the surgery and the site, surgery can take from 15 minutes to one hour. As much as possible, we will endeavour to run to time. In the unavoidable circumstances where there is delay, you will be informed.
What should I do after the procedure?
Rest: you must allow yourself enough rest following your procedure. This will allow the wound to heal better. This will vary depending on the complexity of your procedure, please discuss this with your surgeon.
Work: please check with us about taking time off work and whether you would be able to drive directly after your procedure. In general, most skin surgery will allow you to return to non-physical work immediately or in the next few days, but it depends on your job and most importantly how you feel after the procedure.
Sports and exercise: in most cases, you should not swim, play sports (incl. golf), or exercise (including gardening) whilst the stitches are in place for at least 2 weeks after the procedure – to optimise the appearance of the scar. Depending on the size and site of the surgery you may be asked to refrain from activities that might stretch the scar for a longer period of time (3-4 weeks) after the stitches have been removed. Please ask your surgeon if you are not sure.
Events: please avoid social or stressful events for 1-2 weeks after your procedure to avoid complications to your wound and delayed healing.
When will my sutures be removed?
This depends on the type of sutures that you have had. In general, sutures are removed at 5-14 days depending on the site and type of suture used. Please discuss this with your surgeon. We would be keen for you to have these removed at OneWelbeck so that we can also review the wound and ensure it is healing well.
When can I fly?
With local anaesthetic there are no restrictions to flying, but we would recommend waiting at least 1 week before flying in case of unforeseen issues. Although this advice will be different depending on your procedure and individual patient factors, please discuss this with your surgeon and travel insurance company before your procedure.
Can I eat or drink ?
With local anaesthetic procedures we encourage you to eat light meals before and after your procedure. Please keep yourself well hydrated and avoid any alcohol a day before and at least 2 days after your procedure as this will increase your bleeding tendency and delay healing.
Can I shower or bath?
We recommend having a wash prior to you attending for your procedure. Depending on where on your body the procedure is performed, we will sometimes ask you to avoid getting that area wet for 5-7 days. We will normally apply showerproof (but not waterproof) dressings to avoid the wound getting wet, when you are allowed to have a quick shower. In general, we do not recommend having baths when you have surgical wounds. Please discuss this with your surgeon.
I am having surgery on my face, do I have to take special precautions?
For procedures on the head we advise to avoid bending down after the procedure. This causes congestion and can lead to more swelling of your wound. On the day try to wear slip on shoes to avoid undoing shoelaces and bending down. We recommend avoiding heavy lifting and straining for at least a week after your procedure. Please try to get a week’s worth of shopping in order to avoid carrying heavy shopping bags.
My procedure is on my arm or leg, should I take any special precautions?
On the limbs – especially extremities such as the foot or hand, swelling following the procedure can develop. Therefore we would recommend elevation of the affected limb following the procedure when at home. In certain case, such as with your hand we may put a sling on to keep your hand elevated. This may mean that you will need to reduce your responsibilities and exercises following your procedure, although your surgeon will warn you about these issues prior to your procedure.