Location
Your surgical treatment will usually be done in the Dermatology Surgical Unit, which is situated on Level 2 of the New Victoria Wing of the RVI.
In some cases, your surgical treatment may be done in a procedure room in the outpatient department or one of our peripheral clinics at Cleadon or Cramlington.
For the dermatology department, please enter the New Victoria Wing from the main entrance and keep to the left-hand side where you will see the lift opposite the main reception desk, the stairs behind the lift, or the escalators. Enter the lift or take stairs/escalators to Level 2, upon exiting, turn right and just after the stairs, turn left and follow the corridor until arriving at your destination).
Please enter through dermatology outpatients department, follow the sign for the surgical unit and report to the reception immediately upon arrival.
Cancellation or re-arrangement of appointment
Contact
If you are unable to attend or no longer need your appointment, then please telephone.
Choose option 1 for queries/cancellations regarding an outpatient appointment, or option 2 for the surgical waiting list team to re-arrange your surgery. This is important as it will enable another patient to take your place.
What if my condition changes
If the appearance of your skin lesion changes, or you 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.
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 New Victoria Wing at the RVI. Please be advised a Parking Eye is in operation so drop-offs and pick-ups are restricted to under 10 minutes waiting time. Public transport (metro and buses) is to the Haymarket. This is a short walk to the hospital up St Thomas’ Street. If you require an ambulance to bring you for your appointment you should contact your GP surgery, 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.
Allergic reactions
Allergic reactions to dressings, rubber gloves, skin antiseptic solutions and local anaesthetics are very unusual. Make sure you tell the doctor/nurse if you know you are allergic to any of these items.
Smoking
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 a smoking cessation service.
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 10 minutes before your appointment time as it may be possible to begin your procedure earlier than planned. 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 medications with you when you attend and tell the doctor or nurse if you have a pacemaker or a heart problem that requires 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. You can contact your consultant’s secretary in advance if you have any concerns regarding these additional arrangements.
If you are having treatment on your face, please remove makeup before you attend.
What is being done and why?
A skin biopsy is the 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. If you do not understand the reason for your surgery, we encourage you to ask questions before we begin.
How long will it take?
Usually between 20 and 40 minutes. Some complex or longer procedures may take longer than others. Sometimes, unavoidable circumstances mean that we may be delayed and will inform patients whilst they wait if so. We may ask some patients to take a seat in the waiting room for a short while after their procedure to monitor for any post-operative bleeding.
Who will do the procedure?
Most skin biopsies or excisions are performed by a dermatologist, a dermatologist in training, or a nurse practitioner.
Will it hurt?
Before your operation starts, a local anaesthetic will be injected in order to numb the area of skin involved. This will cause discomfort and stinging for 20 seconds to a few minutes, after which you should not experience any pain. You will, however, still be aware of touch/pressure/pulling sensations. Please inform staff if you feel any undue discomfort during your operation. The anaesthetic will take 2 to 3 hours to wear off in most cases.
What about my stitches/wound care?
As a result of your surgery, you will be left with a wound, which may be closed using stitches and a dressing may be applied. You will be informed how long the dressing should be left in place for and of the wound care afterwards. The stitches used are usually absorbable and do not require removal. Some wounds will be left to heal with dressings only.
Dressing changes may be completed by yourself or a friend/relative or by the nurse at your GP surgery; full instructions will be given to you following your procedure. Some patients will experience bruising and swelling around the wound.
Surgery on the forehead or nose may cause swelling/bruising around the eyes. If you have problems with the wound after surgery, please contact the Dermatology Surgical Unit on the numbers provided in your aftercare information.
Will there be a scar?
Afterwards, there will be a scar or mark where you have had your treatment. The scar will be red at first but will become paler with time.
After a number of months, the scar should be much less obvious. With some patients, the scar may stretch or become thickened (keloid), particularly on the back or chest.
This is due to individual susceptibility – every patient is different – and there is no way that we can know if this will happen. We will make every effort to keep scarring to a minimum.
Diagnosis and results
The diagnosis of your skin lesion will be based on the clinical appearance or the result of a biopsy. It is possible that the diagnosis may change after complete removal and microscopic examination in the laboratory. If the diagnosis changes, it may result in the need for further treatment. You will be told the result of microscopic examination after your surgery either in the clinic or by letter.
Follow-up appointments
Follow-up appointments may be made before you leave the surgical unit, or will sometimes be posted out to your home address. You will also be given information and advice regarding your wound care. It is useful to bring someone with you on the day of your surgery to listen to aftercare advice and ask any questions.
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/near an eye. If in doubt, please seek advice from the doctor or nurse.
What happens to the piece of skin that has been removed?
Tissue removed during surgery is usually looked at with a microscope in the Pathology Laboratory. This will give information about the diagnosis and removal. This process usually takes a minimum of 1-2 weeks. Occasionally further biopsies, surgery or other treatment may be required.
At the end of the procedure, pieces of skin may be left over; these are normally incinerated. These can sometimes 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/nurse 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 rather like a graze, or an open wound.
If stitches are used, these will usually dissolve without removal. Some procedures may require the stitches 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 opening up.
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 you.
If the wound is on your lower leg, you should be prepared after the procedure to rest with your leg elevated for the first 24 hours. You may be advised not to walk more than 400 metres within this time. A bandage may be applied so that you cannot put your shoe on. Bring a loose-fitting sandal or slipper.
What are the risks of having a skin biopsy or excision?
When the local anaesthetic wears off, the wound may 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. Simple painkillers such as paracetamol and Ibuprofen tablets (if able to take) may be required to relieve any discomfort.
The discomfort should start to reduce after 3-4 days. If the pain gets worse, it may mean there is an infection, and you should seek medical advice, primarily using the contact numbers provided. Details on how to contact the department will be given to you after the procedure.
Swelling/Inflammation
This normally lasts for 3-4 days depending on the nature, size and site of the procedure. Bruising is also common and lasts about 1-2 weeks.
Infection
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.
Bleeding
A dressing is usually required, and you will be instructed how to deal with such an eventuality. It may be necessary to restrict your activity in the days following the procedure, and for some, avoid strenuous activity for 3-4 weeks. 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.
For further information or complaints
The Patient Advice and Liaison Service (PALS) can offer on-the-spot advice and information about the NHS. You can contact them on free-phone 0800 032 0202 or e-mail [email protected]
