Skin Surgery

skinsurgery

Skin Surgery is needed for many dermatology problems. Over a thousand operations are done each year in our department.  We use an injection of local anaesthetic to numb the skin beforehand. This is very effective. Small pieces of skin (biopsies) are taken off to analyse in the path lab to help reach a diagnosis. Growths or moles which might be cancerous are removed to be analysed.

  See and Treat Clinics

Some of the surgery is done on planned operating lists but the department does some smaller operations on a “see and treat” basis.  This is a special “one-stop” clinic where the consultation and operation is done in one visit.  The demand for this is difficult to predict so immediate surgery may not be possible, particularly for longer operations.  This is a popular option though for people who travel a long way.  The dermatology department has offered this service since 1995. 

Hygeine and Safety

All procedures are done to the highest standards of hygeine using sterile equipment and gloves and rigorous hand washing by all involved staff. This is to reduce the risk of any infection.  People having operations in dermatology lasting for an hour or more have swabs done before surgery to check there is no sign of the MRSA bacteria which can cause trouble, infecting wounds.  Even so various bacteria can occassionally cause trouble so if the wound is red or sore a few days after surgery, then it is a good idea to let a doctor or nurse check the area to make sure no antibiotics are needed.

All surgery results in a scar, however our staff will try to make this as insignificant as possible. Because suspected skin cancers have to be taken out with an area of clear skin around the growth, the scar is usually longer than many people would first expect.  This will be explained beforehand.   We do our best to make the scar look good but it is not possible to make guarantees as everbody heals differently.   Some people get lumpy, itchy scars called keloid scars. 

Occasionally there is some mild bleeding a few hours later but this rarely causes any problem and can be controlled by steady pressure for five minutes.

 
We realise that most people are anxious when they attend for surgery and try to be sympathetic and as gentle as possible.  We give written instructions afterwards so there is no need to worry about remembering details.
 
Some of the types of surgery done are listed below:

Cryotherapy

This is a way of treating the skin by spraying liquid nitrogen. It only stings a little so anaesthetic is not usually needed. It is used to treat many problems on the skin including warts, small areas of unstable cells on the skin or small skin cancers.
 

Punch Biopsy

This involves an injection of local anesthetic to numb the skin. An area of skin measuring a few millimeters across can then be removed for testing in the path lab using a disposable device which looks a little like a pen. One or two stitches are then applied.
 

Shave Biopsy

A local anesthetic injection numbs the skin. A protruding area which is catching can then be shaved off flush with the skin. An electrical device is used to stop any bleeding.
 

Excision Biopsy

This is used to remove suspicious moles or small skin cancers. An anesthetic injection is used first so there is no pain during the procedure. The areas are cut out with a clear area of normal skin around and then the area stitched up.
 

Grafts or Flaps

If bigger moles are skin cancers and are removed, sometimes the skin heals or looks better if a skin graft or flap are used.  Hundreds of these procedures are done each year in the department.
 

Mohs Micrographic Surgery

 This service was introduced in by Jennifer Garioch and she has now been joined by consultants Eunice Tan, Nasir Syed Shah and plastic surgeon Marc Moncrieff .  It is a technique for removing certain skin cancers.  It is usually used for those near the eyes or nose where sometimes it is not obvious how much skin needs to be removed.   Small sections of skin are examined down the microscope to make sure all the cancer has gone.  Norwich and Cambridge are the only hospitals in the East of England to offer this service.