Removal of a skin lesion advice leaflet

For paediatric pre-operative/post-operative day surgery patients and their parents/guardians.

What is removal of a skin lesion?

Excision of skin lesion is a surgical method of removing an area of abnormal skin growth or lump.

Why remove a skin lesion?

Many skin lesions are harmless, but by removing the lesion it can be sent away to be checked in detail under a microscope in the laboratory, to make a diagnosis. Skin lesions may also be removed if they are causing discomfort and/or if they repeatedly become inflamed or infected. Any skin lesion can only be operated on when there is no current infection

Before the day of your child’s operation.

Your child will need to be assessed by the children’s pre-assessment clinic, The assessment will either be face to face or via a telephone call. This is to check that your child is fit and well for the anaesthetic and to refer them to an anaesthetist for further input if needed prior to the day of surgery. You will also be given fasting times for the day of surgery: no food 6 hours prior to admission time, no breast milk 4 hours prior to admission time and no clear fluids 2 hours prior to admission time.

You will be contacted by the admissions team who will give you a date and time to come in for your child’s operation.

Please make sure that you have a supply of paracetamol and ibuprofen (if your child can take these) at home to give after the operation. These are not routinely given to you to take home after the operation.

If your child is unwell 6 weeks prior to surgery please contact the admissions team to make them aware. as Surgery may need to be postponed if it is taking place under general anaesthetic.

On the day of surgery

When your child arrives on the ward

Please arrive on the ward on the correct date and admission time of your child’s planned surgery. Please make sure that the fasting instructions have been followed. If these instructions have not been followed the procedure may not be able to go ahead as planned.

The time of admission is not the time that your child will go down to surgery. The time your child will go down to surgery is arranged by age and clinical need of the patients on the day.

A nurse will admit your child to the ward. The admission process includes checking your child’s details, whether they have any allergies and checking your child’s temperature, pulse and blood pressure. Numbing cream may be applied to your child’s hands, depending on their age, if they are going to be asleep during the operation.

You will see the surgical team who will gain written permission (consent) from you to say you are happy for the procedure to go ahead. Prior to signing the consent form the surgical team will discuss what the procedure includes and the risks and benefits of carrying out the surgery. You can also ask any questions that you may have about the procedure.

The anaesthetist will also see you and your child prior to going to theatre. They will check that you child is medically fit for the procedure and general anaesthetic (if your child is having a general anaesthetic). They will also discuss the different ways that an anaesthetic can be given, and which method would be best for your child.

In theatre

You can accompany your child to the anaesthetic room if your child is having general anaesthetic. You will not be able to go into theatre with your child.

Once your child is asleep a member of staff will take you to the recovery room, where the staff will ask for a telephone number to contact you on when your child comes out of theatre.

If your child did not have a cannula inserted in their hand in the anaesthetic room, they will have one inserted once they are asleep; this is so medications can be given during the operation and after surgery if required.

The area to be operated on will be cleaned. The area of the piece of skin that requires removing will be marked with a surgical marker pen. Local anaesthetic is injected into the area to “freeze” it. The surgeon will then remove this piece of skin. Which is usually slightly larger than the area of the lesion, to ensure that it is all removed. The skin is then placed in a pot to go to the lab to be examined under a microscope.

The wound is normally closed with dissolvable stitches (if non-dissolvable sutures are used, these will need to be removed in 7 to21 days depending where on the body they are). Glue and/or steri-strips may be used to reinforce the wound and a plaster is sometimes applied over the top, depending on the area of the body the stitch line is on.

During the surgery your child will also be given pain relief, anti-sickness medication and fluids.

After the operation

You will be contacted by the children’s recovery team to inform you that your child is in recovery.

After the surgery your child may feel drowsy or sleepy, they may be restless and upset after waking from the anesthetic (this normally settles on its own).

Your child can eat and drink as they feel able after the procedure.

Your child may have a dressing covering the area where the lesion was. There may be swelling, bruising or soreness to the area, which will settle over the following days/weeks.

You may go home once your child has eaten, taken fluids and passed urine. Before you go home we will also make ensure that your child is comfortable after the procedure.

After you go home

Paracetamol and ibuprofen should be given regularly for the first couple of days.

If the plaster is splash/waterproof or glue has been used you child can have a quick shower after which you should pat the area dry with a towel. Please do not let your child have a bath as the area will become too wet.

It is normal for the wound to ooze after the surgery. If you are at home and you see any fresh blood on the wound or the plaster (if there is one), please contact your GP. If a plaster has been placed over the wound, this can normally be removed at home or by the practice nurse at your GP surgery (if they need to check the wound). After removing the dressing there may be glue covering the stitches. Please leave this to lift off by itself. There may also be dried blood around the stitches, which will normally, gradually come off with gently washing the area. Please do not pull at any dried blood attached to the stitches, as this will be painful and may cause the wound to bleed.

Once the stitches have come out, you can moisturise and massage the scar with simple, unscented moisturiser. This should be done a minimum of two times a day. Scars take up to 18 months to fully mature.

Sometimes the scar can stretch from the original size or become lumpy. If this happens the consultant can discuss options with you to try and rectify this.

Signs of infection

Look out for signs of infection:

• Redness around the wound or spreading away from the wound.
• Increased pain to the wound that is out of proportion to the surgery carried out.
• Hot to the touch, when compared with the temperature of the surrounding skin.
• There is a foul smell coming from the wound.
• There is pus or excessive ooze from the wound.
• Your child has a temperature and feels unwell.

If any of these signs appear please contact your GP, but if your child is very ill, take them straight to A&E.

Medication

Bring all of your child’s medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all the medicines your child uses. During your stay, if your child wishes to take the medication themselves (self-medicate), please speak with the nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

If you are interested in this please let us know and we can provide information, or look on our website: MyChart

Contacts/further information

Paediatric Plastic Surgery Clinical Nurse Specialist:

Telephone: 07729 107964

Email the paediatric plastics department

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.