Background Information:

What are the other Names for the procedure?

• Removal of Skin Lesion

What is Skin Lesion Removal surgical procedure?

Skin Lesion Removal is a surgical procedure that involves the removal of an abnormal, benign or cancerous lesion within the skin.

What part of the Body does the Procedure involve?

• The part of the body involved in the Skin Lesion Removal procedure depends on the location of the abnormal growth on skin
• Typically, such skin growths include conditions such as warts, skin tags, moles, molluscum contagiosum, actinic keratosis, and other skin conditions 

Why is the Skin Lesion Removal surgical procedure Performed?

A Skin Lesion Removal procedure is performed for the following reasons:

• To diagnose a growth abnormality on skin
• Removal of a suspected cancerous lesion on the skin
• Cosmetic issues: Individuals concerned about their visual appearance
• Chronic irritation of the skin due to the lesion
• Allergic skin conditions
• Autoimmune disorders affecting the skin
• Infection of skin

What are some Alternative Choices for the Procedure?

In some cases, freezing a wart (cryotherapy) may be performed instead of removing it. However, for many skin tumors, the Skin Lesion Removal surgical procedure is a gold standard procedure.

What are the Recent Advances in the Procedure?

There have been no recent advances to the Skin Lesion Removal surgical procedure.

What is the Cost of performing the Skin Lesion Removal surgical procedure?

The cost of Skin Lesion Removal procedure depends on a variety of factors, such as the type of health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Skin Lesion Removal and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Skin Lesion Removal surgical procedure:

How is the Skin Lesion Removal surgical procedure Performed?

The Skin Lesion Removal surgical procedure is performed in the following manner:

• The area of the body is identified and cleaned using alcohol swabs or wipes
• Local anesthesia is given around the skin lesion
• Using sterile techniques, a scalpel is used to remove the skin lesion
• The wound is then closed using sutures
• If the size/area of skin removed is large, then a skin graft may be used to cover the area
• Occasionally, a punch biopsy may be performed to remove the skin lesion
  • In this case, a punch biopsy instrument is used instead of a scalpel, to remove the skin lesion
  • A punch biopsy is usually used to remove small lesions
  • No skin graft is necessary following removal of skin lesion using this technique
• Another method for Skin Lesion Removal surgical procedure is a shave biopsy
  • This is often used to remove small skin lesions that are thin and not affecting the deeper skin tissues
  • No skin graft is necessary following a shave and biopsy removal of skin lesion 

Where is the Procedure Performed?

A Skin Lesion Removal procedure can be performed in an out-patient surgery center facility, a physician’s clinic/office, an emergency room, or a hospital.

Who Performs the Procedure?

The procedure is performed by any of the following medical personnel, with or without assistance from an anesthesiologist:

• General surgeon
• Family physician
• Dermatologist
• Plastic surgeon
• Reconstructive surgeon
• ENT surgeon
• Any qualified healthcare provider

How long will the Procedure take?

This depends upon the type of the procedure. A majority of Skin Lesion Removal procedures take between 5-20 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Skin Lesion Removal procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

The following preparations may be performed prior to a Skin Lesion Removal procedure:

• The physician may evaluate the individual’s medical history to gain information related to the overall health status including the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency, or any other medical condition that prevents the individual from undergoing the procedure
• Normally local anesthesia is used; do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Skin Lesion Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Skin Lesion Removal surgical procedure?

• Before a Skin Lesion Removal procedure, the individual does not usually have to undergo any test
• Occasionally, routine blood analysis may be performed to assess risk of bleeding

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Skin Lesion Removal procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Skin Lesion Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection, or general anesthesia by injection is usually administered prior to the procedure. 

How much Blood will you lose, during the Procedure?

The blood loss during a Skin Lesion Removal surgical procedure is usually minimal.

What are the possible Risks and Complications during the Skin Lesion Removal surgical procedure?

There are general factors that increase the risk of getting complications during Skin Lesion Removal surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgical procedure are:

• Excessive bleeding
• Infection within the surgical wound
• Anesthetic complications, which are usually minor, since local anesthesia is used

What Post-Operative Care is needed at the Healthcare Facility after the Sentinel Node Biopsy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Skin Lesion Removal surgical procedure: 

What are the possible Risks and Complications after the Skin Lesion Removal surgical procedure?

The possible risks and complications that may arise after a Skin Lesion Removal procedure include:

• Excessive bleeding
• Infection within the surgical wound
• Recurrence of the lesion
• Excessive scarring, called keloid formation, might occur
• Discoloration of skin
• Nerve damage

What is the Prognosis after the Surgery?

A complete recovery from the Skin Lesion Removal surgical procedure is usually achieved, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling within the surgical wound
• Excessive bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea or vomiting
• Signs of an infection
• Headache
• Fever
• Dizziness
• Muscle aches
• Feeling sick

What Post-Operative Care is needed at Home after the Skin Lesion Removal surgical procedure?

At home, the following post-operative care is recommended, after a Skin Lesion Removal procedure:

• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild unscented soap.  Replace dressing after showering
• Apply antibiotic ointment to treat discharge surrounding the surgical wound
• Avoid taking non-prescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, under advice by the physician

How long does it normally take to fully recover, from the Procedure?

Skin Lesion Removal is a minor surgical procedure. Most individuals are able to carry out their daily activities immediately following the procedure. The healing of the wound depends on the size of the skin tissue removed.

• For a shave or punch biopsy, the skin heals completely between 1 to 4 weeks
• For excisional skin lesion removal, the skin healing may take longer
• The sutures are generally removed between weeks 1 and 2
• Sometimes, the healthcare provider may use “self-absorbable” sutures. In such cases, the sutures need not be removed, because they tend to fall-off when the skin heals

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the
Procedure?

• The skin tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Skin Lesion Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, physician’s clinic/office, or a hospital
• A pathologist (if the tissue was sent for analysis)
• A general surgeon, family doctor, dermatologist, plastic surgeon, or a reconstructive surgeon, or any other healthcare provider who is qualified to perform a skin biopsy

The patient is advised to inquire and confirm the type of billing, before the Skin Lesion Removal is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA