Skin Lesion Excision / Removal

What is a skin lesion?

A skin lesion is any lump or bump that arises from the skin.  There are many types of skin lesions most of which are benign and harmless and can safely be left alone.  Sometimes however a skin lesion can be unsightly or cause pain and discomfort, particularly if it catches or rubs on clothing.  Benign skin lesions are not usually excised on the NHS unless there is suspicion of cancer or it is causing significant problems.  If you want a skin lesion removing for cosmetic reasons you will usually need to pay for this as a private referral.

On occasion skin lesions are either confirmed or suspected as being malignant or cancerous.  If your GP is suspicious of this you will be referred via the NHS to a specialist skin cancer clinic.

Different Types of skin lesions

Examples of benign skin lesions include:

• Moles
• Keratoses
• Skin tags
• Warts
• Epidermoid / sebaceous cysts
• Lipoma (benign fatty growth)

Malignant skin lesions include:

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma

Treatment of a skin lesion

Most skin lesions can be left alone.  Your GP will advise you of the treatment options available.  Techniques to remove a skin lesion include:

Shave / partial excision

This technique is used to treat certain lesions such as skin tags and actinic keratosis.  Your surgeon will cut the lesion off at the level of your skin, and usually use diathermy (cautery) to seal the blood vessels on the skin. 

Complete excision

This technique is used for larger skin lesions such as moles, and an ellipse of skin is excised with the lesion in the middle.  The skin is then closed with sutures.

Epidermoid cysts are usually removed with a small ellipse of skin over the punctum of the cyst, and the cyst is removed completely.  The skin is then closed with sutures.

Lipoma are usually excised with an incision over the lesion, the lipoma is then dissected from the surrounding tissue and removed.  The skin is then closed with sutures.

Curettage (scrapping away)

This technique can be used for warts and is sometimes combined with cautery or cryotherapy.  A curette is used to scrape away the lesion.

Cryotherapy (freezing)

This technique involves using liquid nitrogen which is applied to the lesion.  The lesion will usually blister and then fall off with the blister in the days following the treatment.

If complete or partial excision of a skin lesion is recommended your GP may refer you to a surgeon.

Excision of a skin lesion

Skin lesions are usually removed under local anaesthetic.  The area around the lesion will be cleaned with a special anti-bacterial cleaning agent and a surgical drape will be used to maintain a sterile operating field.

Local anaesthetic will be injected into the area.  Example of local anaesthetics include lignocaine (lidocaine), levobupivicaine, chirocaine.  If you are allergic to local anaesthetics please inform your surgeon as soon as possible.

The lesion will then be removed, as described above.  Sutures, if used, will sometimes be dissolvable, but usually you will need the sutures removing.  Your surgeon will explain when these should be removed after your operation.  Your sutures will usually be removed by the practice nurse in your GP surgery. 

The excised skin lesion will usually be placed in a jar and sent for analysis.  This is when a pathologist will assess the lesion using special stains and look at it under a microscope.

Risks and Complications of surgery

Generally speaking skin lesion excision is very safe with a low risk of complications. 

Following surgery most patients will experience slight discomfort and some minor swelling or bruising at the operation site.  This usually settles within a few days.  Sometimes over-the-counter painkiller medication, such as paracetamol or ibuprofen is required, and this is usually only necessary for the first few days after surgery. 

Complications of skin lesion excision include:

Scar

It is important to realise that excision of a skin lesion will leave a scar. Your surgeon will do their best to keep this scar as minimal as possible, but there will be a scar present.  The size of the scar will depend on several factors including the size of the lesion and how much skin needs to be removed.  Scars tend to fade over time.

Very rarely a keloid scar forms.  This is overgrowth of normal scar tissue and leads to a red, raised, sometimes itchy scar.  It is more common if you have dark skin and if you or a relative has had a previous keloid scar.  Sometimes it is best to avoid surgery if possible if this is the case

Infection

Infection can involve the wound, which then becomes hot, red, swollen and painful.  There is sometimes discharge from the wound.  Some wound infections require a short course of antibiotics, more rarely a further operation is required.  If you develop a wound infection the scar may be more prominent.

Bleeding

Minor bruising is common following skin lesion excision.  Any other bleeding is exceptionally rare and is controlled at the time of the operation, but afterwards there is small chance bleeding can occur.  This can lead to a haematoma related to the wound.  Should this occur it tends to resolve gradually over a few weeks. 

Seroma and persistent lump

A seroma is a collection of fluid at the site where the lesion used to be.  This is more common after a larger lesion is excised that leaves a space under the skin, such as with a large lipoma or epidermoid / sebaceous cyst.  Over time seroma will slowly resolve.  Very occasionally a seroma will need to be aspirated with a needle.

Recurrence of the lesion

There is no method that will give a 100% guarantee that the lesion won’t recur.  This is more common with certain types of lesions, particularly epidermoid cysts and lipoma. 

Occasionally a lesion is excised, which was thought to be benign, and a skin cancer is found when it is analysed in the laboratory.  This will sometimes require further surgery to excise the scar to obtain a wider margin around the tumour.

Numbness around the scar

Sometimes you will notice a numb patch around the scar.  Occasionally there is a burning or altered sensation.  This is due to the cutaneous nerves being damaged, but is usually temporary and resolves over time.

After your operation

After having your skin lesion removed, your wound may take between 5 days and 2-3 weeks to heal.

If you had stitches which are not dissolvable your surgeon will advise you when these need to be removed. Usually, this is between 7 & 14 days post-operatively depending on the site on the body.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen.

Generally you will be advised to avoid stretching the surgical area for 2-3 weeks afterwards.  The wound would normally be need to be kept dry for 48 hours and then clean it gently daily.

If the area where your skin lesion was removed becomes hot, red, swollen and painful, see your GP. You could have an infection in the wound and you may need to have some antibiotics.

You should be able to return to work following skin lesion excision, unless your work puts excessive strain on the site of surgery.  Ask your surgeon about when you will be able to return to normal activity and work.