Skin Surgery
Skin cancers including basal cell carcinoma, squamous cell carcinoma, and melanoma can be surgically removed right in your dermatologist's office with just a few injections of local anesthesia. Many benign lesions such as birthmarks, moles, keloid scars, cysts,and hemangiomas are also surgically removed under local anesthesia. You will be able to drive home after the procedure.
Before your Surgery:
- You are taking aspirin, ibuprofen, Coumadin, Plavix, other blood thinners, or herbs or vitamins that cause bleeding such as ginger, gingko, garlic, ginseng, feverfew, Vitamin E or St. John's wort.
- You are taking anti-inflammatory, anti-arthritis, anti-pain medicines or certain herbs for inflammation, pain, or arthritis.
- You have ever had a reaction to a local anesthetic such as Novocain or Xylocaine.
- You have heart trouble, artificial heart valves or a pacemaker.
- You are allergic to antibiotics or to bandage tape.
- You have artificial joints.
- You are instructed to take antibiotics before a dental or surgical procedure.
Aspirin, ibuprofen and Advil make people bleed more easily, and we prefer that patients not take it for two weeks before and two days after surgery. If you are taking an aspirin-containing medicine on your own, please stop two weeks prior to surgery. However, if you are taking aspirin on a doctor's order, ask your doctor if you can temporarily stop it. If your physician allows you to stop it, please do so two weeks prior to surgery and resume two days after surgery. We do not stop Coumadin or Plavix before the skin surgery but would appreciate knowing that you take these medications.
Aspirin containing medications include: Bufferin, Anacin, Alka-Seltzer, Ascriptin, Excedrin, Bayer, Ecotrin, Empirin, 4-Way Cold Tablets, Arthritis Pain Formula, BC Powder, Cama Arthritis Pain Reliever, Momentum Backache Formula, Vanquish and others.
Do not substitute other anti-inflammatory, anti-arthritis, or anti-pain medications for aspirin (except Tylenol) without checking first with your doctor.
The Surgical Procedure:
The surgeon will first mark the lesion to be removed. For skin cancer, an extra margin of tissue will be marked to ensure complete removal. The amount of skin removed will be larger than what was removed for the biopsy. Additionally, tips will be removed to allow for smoother closure. Typically, this will require the excision to be 3-4 times as long as it is wide.
After the area is marked by the surgeon, an assistant will numb the site, usually with Xylocaine with Epinephrine, unless you have a problem with either. Xylocaine is the anesthetic and Epinephrine constricts blood vessels to decrease bleeding. Epinephrine can sometimes make your heart race or make you feel jittery.
The needle is very fine and you will barely feel it. The anesthetic solution stings briefly while being injected, but there is no pain during surgery. You will be conscious during surgery. Therefore, you will be able to drive yourself home afterward.
The surgeon will remove the marked skin and send it to the lab. Sections will be cut and checked to see that the tumor is completely removed. Bleeding will be stopped with cautery. The skin edges will then be sewn closed. Sutures will be removed in 5 to 21 days, depending on the location (legs take longer to heal than the face).
After Surgery:
Your incision will be dressed by an assistant before you leave the office and you may be given an additional dressing to use after the first day. The incision should remain covered until the sutures are removed. If the dressing is not soiled it is best not to remove it until you return to the office. Please do not use any creams containing Neosporin, Bacitracin or Triple Antibiotic Ointment since these commonly cause allergies. Do not apply hydrogen peroxide, alcohol or soap to the incision.
Aftercare instructions:
When you arrive home after your surgery, take it easy and do not engage in exercise, lifting or bending, as this may cause the sutures to give way or bleeding at the incision. Sit or lie quietly and use a bag of frozen peas over the incision to reduce swelling for the first day. After the first 24 hours you may increase your activities.
You will need to keep the excision site dry for at least 24 hours. You may take a shower the next day.
Most bleeding can be controlled by holding pressure directly over the incision for 20 minutes. If you experience excessive bleeding or significant pain or redness at the surgical site, please call your physician, or if after hours, call the emergency room.
If you haven't done so before, you should begin taking Vitamin C, 3,000-5,000 mg per day which you can take in divided doses. Vitamin C is important for collagen synthesis which is the chief component of scar tissue. A stronger, thinner scar will result if you take Vitamin C for at least 3-6 months after your surgery.
Is there scarring?
When a cut heals it does so by forming a scar. Every effort is made during surgery to minimize the scar. Often a scar may be barely visible, especially if the skin is wrinkled. However, on the chest, shoulders, back, arms and legs, scars may spread, often become thickened, and may not be cosmetically acceptable. Moderate doses of Vitamin C (3,000-5,000 mg per day) taken during the wound healing process for 3-6 months will result in a stronger, thinner scar in most cases. Please inform your physician if you have a history of forming keloid scars.
Post Operative Complications:
- Unexpected reaction to local anesthetic. These are very rare and can include wheezing, hives or a rash. Please report these to your physician immediately.
- Post operative bleeding. As outlined above, pressure for 20 minutes over the incision should stop the bleeding but if not, call your physician.
- Post operative infection. Increasing pain, redness or pus at the incision site should prompt a call to your physician.
- Poor wound healing and scar formation. With adequate Vitamin C supplementation, above, this should not occur. Please advise your physician if you have a history of poor wound healing.
- Numbness in adjacent skin. This is a fairly frequent complication since small nerves may be cut during removal of the tumor. Generally, the nerve will regrow within a period of 6-12 months and the sensation will return. You may also experience tingling or pain while the nerve is regrowing into the area. Homeopathic Hypericum can sometimes relieve these symptoms.
- Recurrence of original lesion. This may occur in up to 3% of cases. A second surgery would then be necessary.
Follow Up Evaluations:
You will also want to review the causes of skin cancer such as sun damage and premature aging and make appropriate lifestyle changes to avoid skin cancer recurrence.
What is Mohs Surgery?
Mohs Surgery is indicated for tumors on the eyelids, nose, ears or lips, where it's important to take the least amount of tissue necessary, yet fully remove the tumor. It is also used for specific types of skin cancers and if a cancer has recurred after a surgical procedure.
This site and the information contained herein is made available by the author for educational purposes only and is not intended to provide medical advice for any specific person or condition. By accessing the site, you understand and acknowledge that there is no physician-patient relationship between you and the author. You further acknowledge your understanding that the site should not be used as a substitute for competent medical advice from a licensed physician in your state. Robin Fleck, MD does not practice medicine or offer advice over the internet. By further accessing the information contained in this web site, or by further internet communication with us, you agree to waive any future claim against us that you reasonably or detrimentally relied upon information provided by us either through this web site or email. NO warranty whatsoever is implied by our statements on Rejuvadoc.com. Robin Fleck, MD reserves the right to edit any question posed, to combine questions and to respond to only those questions deemed to be of broad interest.