Need any help? Call us at 020 3962 2083!

Having a biopsy - Information for patients on skin surgery

This leaflet provides information about your skin surgery procedure. We hope it answers some of the questions you, or those who care for you, may have. It is not intended to replace the discussion between you and your Dermatology team but aims to help you understand more about what is discussed. If you have further questions, please do not hesitate to discuss with your doctor.

Types of skin procedure

Skin surgery involves removing a sample of skin to examine under the microscopy. The type of procedure you will have depends on the nature of your skin condition, but it will be one of the following:

  • Punch biopsy: a small circle of skin is removed, usually the size of a lentil. A stitch is used to close the wound.
  • Shave excision and cautery: a horizontal cut is made to remove lesions raised on the surface of the skin. A hot instrument (cautery) is used to stop any bleeding.
  • Curettage and cautery: a scoop shaped instrument called a curette is used to scrape away the skin lesion. A hot instrument (cautery) is used to stop any bleeding.
  • Incision biopsy: part of the lesion is removed. Stitches are used to close the wound.
  • Excision biopsy: the whole lesion is removed, including a surrounding area of normal skin. Stitches are used to close the wound.

What do I need to do before my procedure?

Please tell us before the day of your procedure if:

  • you are taking warfarin, aspirin or any other blood-thinning medicines. If you are taking warfarin, please ensure you have your international normalised ratio (INR) checked one to three days before the procedure. If the result is over 3.5 then it is likely we will have to reschedule the surgery. Please bring the result of your INR test and your yellow warfarin book with you when you come in for your procedure.
  • you have any bleeding disorders.
  • you have an implantable electronic device, such as a pacemaker or defibrillator. This is important because we may need to speak to the department that installed the device beforehand.

On the day of the procedure

You can eat and drink (non-alcoholic) fluids. Please take any other regular medicines as normal.

If you are having a procedure on your scalp, please make sure that your hair is free from any hair products such as hair spray, mousse, or gel. This is because we may use a hot instrument (cautery) to stop any bleeding and these products can sometimes be flammable (catch fire). A scalp biopsy often requires more than one sample to be taken.

If you are having a procedure on your finger or toenails, please remove any nail varnish (including clear nail varnish).

If the procedure is elsewhere on your body, we advise that you wear loose or comfortable clothing so that your clothes do not rub the wound afterwards.

We will ask you to keep your wound dry for at least 48 hours after the procedure so please have a shower or bath beforehand.

What will happen when I arrive?

Please arrive on time for your appointment. We cannot guarantee that the procedure will go ahead if you are late.

When you arrive, please remind the doctors or nurses about any medications you are taking, any allergies you may have, if you are pregnant, or if you have an implantable electronic device. Please bring any information about your implantable electronic device with you.

You will have the opportunity to ask questions before the operation. The doctor or nurse will explain what it involves and discuss potential problems that you may experience afterwards. We will ask you to sign a consent form to confirm that you understand the information provided and that you agree to go ahead with the procedure.

You may need to change into a hospital gown to protect your clothing or for us to gain better access to the part of your body where the procedure will take place.

What does the surgery involve?

A doctor and nurse/health care assistant will be present. Surgery usually takes 20-30 minutes per lesion, but occasionally it may take longer.

We will give you a local anaesthetic injection to numb the skin. The local anaesthetic may sting/burn, but this will last less than 30 seconds. You may feel pressure and movement whilst the procedure is being carried out.

The skin sample will be removed and then the wound will be closed or sealed.

Will I need stitches?

After a punch biopsy, incision biopsy or excision biopsy, the wound will usually be closed with stitches. If non-dissolvable stitches are used these need to be removed at the clinic or at your GP surgery after one to two weeks. Please ensure that you can attend. If you can’t, for example, because of a holiday, please tell the doctor doing your procedure beforehand.

The choice of suture (dissolvable vs non-dissolvable) will be chosen by your doctor and will be based upon the nature of the surgical procedure, its size and location.

What happens after the procedure?

The local anaesthetic wears off after two to three hours. You may need to take paracetamol to relieve pain after this. Do not take non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen as these can increase bleeding.

The wound will usually be covered with a dressing which should be left on for 48 hours and kept dry. The doctor or nurse will give you further advice on wound care (and stitch removal if needed).

It is important to protect the wound to help healing and reduce scarring. Until the stitches have been removed, please avoid the following:

  • Sport
  • Straining
  • Exercise or Gym
  • Heavy lifting
  • Swimming
  • Putting the wound underwater e.g. in a bath
  • Driving, especially if the wound if on the foot or lower leg

Depending on where on the body your surgery was, we may advise you to avoid activities that can stretch the wound for four weeks after the procedure.

What are the risks involved in having skin surgery?

A separate consent form will cover this in more detail, but skin surgery is generally safe. Potential risks include:

  • Bleeding: if there is bleeding from the wound, apply pressure to the dressing for at least 15 minutes and keep the affected area raised. This will usually stop the bleeding. If the bleeding continues, return to the clinic if it is between 09.00 and 17.00. Outside of these hours go to your nearest A&E department.
  • Bruising: bruising may occur, especially if the procedure is near the eyes. This will disappear after 7 to 14 days and will not leave any permanent mark.
  • Infection: if the wound becomes very red, painful, hot, swollen, or oozes (leaks), it may be infected. You should see your GP who may prescribe antibiotics. The risk of infection is increased in smokers, people with diabetes and immunosuppressed patients.
  • Scarring: there will be a permanent scar after skin surgery. Unfortunately, this cannot be avoided. For excision biopsies, the length of the scar is approximately three times the length of the lesion being removed. Please follow the wound care advice listed in the previous section to help reduce scarring.
  • Wound breakdown: rarely, wounds can break open after surgical procedures. If this happens, please see your GP who may advise wearing dressings for a longer period of time.
  • Rarer risks include nerve damage and an allergic reaction to the local anaesthetic.

Are there alternative treatments to skin surgery?

You do not have to have skin surgery. Whilst your dermatologist has recommended it, other investigations or treatment options may be available. If you have specific concerns about skin surgery, it is important to discuss these with your dermatologist in order to explore the risks and benefits of all available options.

Contact information for the clinic

  • Address: 498-504 Fulham Rd., London SW6 5NH
  • Email: hello@drdropin.uk (mailto:hello@drdropin.uk)
  • Phone: 02039622083