Minor Surgical Procedures in Dermatology

Minor surgical procedures are commonly performed in dermatology for both diagnostic and therapeutic purposes.

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Patient Information

Below is an overview of various procedures, their indications, and what to expect before and after surgery.

 

1. Curettage & Cautery

Indications:

  • Superficial basal cell carcinoma (BCC)
  • Actinic keratoses
  • Seborrhoeic keratoses
  • Viral warts
  • Small, non-melanocytic lesions

Procedure:

  • A curette (a sharp, spoon-shaped instrument) is used to scrape away the lesion.
  • Cautery (heat or electrical current) is applied to stop bleeding and destroy residual abnormal tissue.

Aftercare:

  • Keep the wound covered for 48 hours.
  • A crust will form, which falls off in 1-3 weeks.
  • Apply petroleum jelly or a prescribed ointment to aid healing.

Do’s and Don’ts:

  • Do keep the wound covered until fully healed.
  • Do expect mild redness and scabbing.
  • Don’t pick at the scab-it helps prevent scarring.
  • Don’t expose the area to direct sunlight until fully healed.

2. Shave Excision

Indications:

  • Seborrhoeic keratoses
  • Skin tags
  • Superficial benign naevi (moles)
  • Small, raised lesions

Procedure:

  • A dermablade (a flexible, fine razor-like instrument) is used to shave off the lesion at or slightly below skin level.
  • The area may be treated with cautery to minimise bleeding.

Aftercare:

  • Expect a scab to form, which will drop off within 1-2 weeks.
  • The site may appear slightly pink before normal skin colour returns.

Do’s and Don’ts:

  • Do apply a moisturising ointment to prevent dryness.
  • Do protect the area from sun exposure to avoid pigmentation changes.
  • Don’t scratch or rub the healing area.

3. Incisional Biopsy

Indications:

  • Suspected malignancies (e.g., melanoma, squamous cell carcinoma)
  • Inflammatory skin conditions requiring histological diagnosis

Procedure:

  • A small portion of the lesion is removed using a scalpel for laboratory analysis.
  • The wound is typically closed with a few stitches.

Aftercare:

  • Sutures are usually removed within 5-14 days, depending on the site.
  • Keep the area clean and dry for at least 24 hours.

Do’s and Don’ts:

  • Do follow instructions for wound care to prevent infection.
  • Do limit movement if the biopsy site is in a high-tension area.
  • Don’t engage in strenuous activity until stitches are removed.

 

4. Punch Biopsy

Indications:

  • Inflammatory skin conditions (e.g., lupus, psoriasis)
  • Suspected malignancies (melanoma, SCC, BCC)
  • Unexplained rashes or dermatoses

Procedure:

  • A circular blade (punch tool) is used to remove a small core of tissue.
  • Depending on the size, the wound may be closed with stitches or left to heal naturally.

Aftercare:

  • If stitches are used, they will be removed after 7-14 days.
  • Mild bruising and tenderness are normal.

Do’s and Don’ts:

  • Do apply prescribed antibiotic ointment.
  • Do monitor for signs of infection (increased redness, swelling, or discharge).
  • Don’t soak the area in water (e.g., baths, swimming) until fully healed.

5. Excision

Indications:

  • Suspicious skin lesions (e.g., melanoma, SCC, BCC)
  • Dysplastic naevi (atypical moles)
  • Benign growths causing discomfort or cosmetic concerns

Procedure:

  • A scalpel is used to remove the lesion along with a small margin of surrounding tissue.
  • The wound is closed with stitches.

Aftercare:

  • Stitches are removed after 5-14 days, depending on the site.
  • Scar management (e.g., silicone gel, massage) may be recommended.

Do’s and Don’ts:

  • Do keep the wound clean and dry for at least 24 hours.
  • Do take pain relief (e.g., paracetamol) if needed.
  • Don’t lift heavy objects or stretch the area excessively.

6. Wide Local Excision (WLE)

Indications:

  • Confirmed melanoma requiring removal of a wider margin
  • High-risk squamous cell carcinoma
  • Recurrence of previously treated skin cancer

Procedure:

  • A larger area of skin is removed to ensure no remaining cancerous cells.
  • The wound is closed with stitches or, in some cases, a skin graft or flap may be needed.

Aftercare:

  • Dressings may need to be changed regularly.
  • Healing can take several weeks, especially for larger excisions.

Do’s and Don’ts:

  • Do follow wound care instructions carefully.
  • Do attend follow-up appointments to monitor healing and recurrence.
  • Don’t engage in strenuous activities that may stretch the wound.

What to Expect on the Day of Surgery

  • Preparation: The area will be cleaned, and local anaesthetic will be injected.
  • Procedure Time: Most minor dermatological surgeries take 15-45 minutes.
  • Sensation: You may feel pressure or tugging but no pain due to anaesthesia.
  • Aftercare Instructions: These will be provided before you leave.

Do’s and Don’ts After Surgery

Do’s:

  • Keep the wound clean and dry.
  • Follow instructions on dressing changes.
  • Use prescribed ointments or creams as directed.
  • Take mild pain relief if needed.
  • Protect healing skin from the sun.
  • Attend follow-up appointments if scheduled.

Don’ts:

  • Don’t pick at scabs or remove dressings early.
  • Don’t get the wound excessively wet (showers are usually fine; avoid baths and swimming).
  • Don’t engage in vigorous exercise until cleared by your doctor.
  • Don’t apply harsh skincare products to the area (e.g., retinoids, exfoliants).

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