We undertake minor surgery lists at Talbot Medical Centre on a Tuesday morning.

Procedures are performed under local anaesthetic and include:

• Excision/biopsy of certain skin cancers (BCC)
• Excision of sebaceous cysts/lipomata
• Wedge resection/Zadek procedure for treating ingrowing toenails
• Removal of certain other non-cancerous skin lumps

The criteria we are required to use to assess patients for eligibility for surgery are not decided by us and we are not able to remove all lumps or bumps which you may be concerned about. This service does not cover cosmetic removal such as skin tags.

If you are concerned about a skin problem or ingrowing toenail please arrange a consultation with a clinician.

If you are booked for a minor procedure and the lesion changes (either worsens or gets better), please speak to your GP before the procedure as we may need to change your treatment plan - if the procedure is no longer needed we can offer the appointment slot to someone else.

Where will it take place?

Your procedure will take place in our minor surgery treatment room and the doctor will be assisted by one of our practice nurses.  As we are a training practice, medical students or GP registrars may be present, but if you are not happy with this please let us know.

Can I eat as normal on the day of the procedure?

Yes

Can I continue to take my medication?

There is no need to stop taking most of  your medication but if you are taking any medication to thin your blood such as Aspirin / Clopidogrel / Dipyridamole / Warfarin / Apixaban / Rivaroxaban / Dabigatran or similar, you need to ensure that you have discussed with your doctor about when to stop or temporarily reduce your dose before your procedure.

What do I do if the lesion/lump falls off on its own before the procedure?

Please call reception to postpone the procedure and make a routine appointment to speak to your GP to decide if any further action is needed. Please do not just attend for you minor surgery appointment as a way to ‘just get it checked’. These appointments are special slots for a procedure to take place and if you use this slot to ‘get it checked’ you are using up an appointment which someone else might need, potentially to have a skin cancer removed.

Will I have to sign a consent form?

Yes. Before the doctor performs the procedure we need to ensure that you have been fully informed about the nature of the operation and the risks involved. Even at this late stage you can still decide not to proceed. An explanation about the complications and risks is detailed below, please make sure you understand this information fully, and ask your doctor any questions that you might have.

Will it hurt?

Your procedure will be carried out under a local anaesthetic which is injected into the skin around the area to be operated on. This can sting as it goes in, but very shortly the area goes numb. You may be able to feel a pulling sensation and pressure at times but you should not feel pain. Sometimes more local anaesthetic is needed during the procedure and therefore, if you experience any pain during the procedure, inform the doctor or nurse immediately. You will remain awake throughout.

The anaesthetic normally wears off after a couple of hours, after which the area may be a little sore. We advise that you take some simple painkillers for this such as paracetamol or ibuprofen if you can tolerate this.

Will I need stitches?

This will depend on what procedure is carried out. If you do have stitches the doctor will tell you when you should come back to have them taken out; you will also be advised if you need to come back to see the practice nurse for any dressing changes.

Please inform the doctor if you:

• Have any known allergies especially to anaesthetics, antibiotics, latex or dressings
• Have a pacemaker or similar implanted device
• Have any metalwork or joint replacements
• Have problems with lying flat for up to thirty minutes
• Have problems with wound healing or suffer with any medical conditions that may affect the wound e.g. Diabetes or Rheumatoid Arthritis

Can I drive afterwards?

We generally advise that someone comes with you to take you home after the procedure, or arrange a taxi to take you home.

When will I be informed of any biopsy results?

Results are usually available within a few weeks. Normally we will either call or send an SMS to inform you of the results. Please let us know if you are not happy to receive the results via SMS. If you have not heard anything after six weeks please contact reception to check your results.

Holidays / Special Events

If you are travelling abroad or on holiday or attending a special event within three weeks of surgery please reschedule your procedure by phoning 01202 636400. This is because of the risk of post surgical complications, and dressing and stitches will need to be removed. There may also be bruising / swelling; you may not look or feel your best for a special event.

Infection

1 in 100 risk. Sometimes the treated area can become infected. This gives rise to pain, swelling and redness, or there may be some pus present. This can cause delayed wound healing and might require further surgery. Please contact your GP as soon as possible, or the Out of Hours Service / A&E. Very rarely the infection can spread into the blood stream and cause sepsis, or an overwhelming infection. This is an emergency and can become life threatening.

Wound Dehiscence (wound breaking open)

The most likely time for this to occur is just after the stitches have been removed or if the wound has become infected. Further procedures and specialist input might be required.

Pain

The wound may be painful for 24-48 hours after the local anaesthetic wears off. If the pain is not improving after 48 hours please call in to see the Nurse. Very rarely the pain can be permanent.

Nerve Damage

Sensation: When an area of skin is removed, some small nerves in the skin will be cut. This may result in a small area of numbness around the wound, or can lead to chronic pain. Although recovery usually occurs, normal sensation can take many months to return and occasionally reduced sensation or pain may be permanent.

Movement: It is extremely rare to cause damage to nerves that deal with movement. However there are certain areas, especially on the face and neck, where surgery could cause damage to such nerves especially if the nerves are abnormally placed or hidden within a tumour.

Recurrence

We will do our best to ensure that the skin lesion being removed is complete, but this might not always be possible. In these instances the original skin complaint might recur.

Non-Resolution of Symptoms

Sometimes the procedure performed will not be successful in alleviating the symptoms as intended. If this is the case, further procedures or treatment options might be needed if available.

Scarring

Every minor surgery procedure will leave a permanent scar – it is impossible to remove anything without leaving a scar. As a general rule, the length of the scar is three times the width of the lump to be removed. Some people with heal with a much more prominent and thickened scar than others. It is impossible to predict if this will occur. Avoid any sports or exercise that might stretch the scar.

Keloid Scarring

This is an over-reaction of the fibrous tissue/scar in your skin. It does not happen immediately but develops a few weeks after surgery. Keloid scars are due to an individual’s inherent tendency to form scar tissue. They are more common on the front of the chest, upper arms and upper back, and in scars which have not been sufficiently immobilized. They are also more common in Afro-Caribbean skin types. They can become very painful and tender and cause cosmetic embarrassment. Further procedures might become necessary to try and improve your symptoms.

Bleeding or Bruising

It is normal for a small amount of bleeding to occur immediately after minor surgery. Continuous pressure for 10-15 minutes is usually enough to stop bleeding. Elevation of the affected area (such as a limb or head) will also help. Very occasionally a wound may bleed sufficiently to need re-stitching or a small blood vessel may need re-coagulation. We will review patients at our clinics if such a problem occurs. If the bleeding persists contact your GP, the Out of Hours Service or A&E.

Allergic Reaction

Any dressing or medication has the potential to precipitate an allergic reaction even in someone who has previously encountered the same dressing or medication without problem. Symptoms can vary from discomfort, pain, redness or swelling to life threatening anaphylactic reaction. A severe allergy to the local anaesthetic is extremely rare.

The adrenaline in the local anaesthetic can rarely cause a feeling of rapid heartbeat (palpitations). We can exclude the adrenaline if this has happened to you before. If you have had problems with local anaesthetic in the past, please let us know.

Cosmetic Embarrassment

The proposed procedure is not intended to be a cosmetic procedure. Although we will strive to achieve an acceptable cosmetic result, it can’t be guaranteed. This may lead to cosmetic embarrassment.

The procedure to remove part of your toenail is classed as a "minor" procedure but you will need to be prepared for a few weeks of recovery after this procedure.

When you leave the surgery, you will have a big bandage on your toe which will mean that you probably won't be able to put your shoes back on (we suggest you come with some flip-flops. You will need to put your foot up for the rest of the day. When the anaesthetic wears off after an hour or two it may be a bit sore (take some paracetamol or ibuprofen if you are able to).

You will need to keep it completely dry until you come back for our nursing team to redress it a week later. You may well need a further appointment for dressings after that

It may be a few weeks before you are wearing your normal shoes comfortably again, and often a bit longer before you would want to play football.

If your work requires you to stand for prolonged periods or you need to wear reinforced footwear you should discuss the procedure with your employer before you come in for it so you can agree how this will be managed.

Much of the skin surgery we do requires suturing (stitching). Please be aware that you will need to look after the wound carefully - whilst the sutures usually come out after 7-14 days (depending on the site and size of the procedure), it will take six weeks or more for the skin to return to full strength. If you have an operation on your shoulder, for example, you may need to avoid swimming or playing tennis (anything that stretches or strains the skin in that location) for a month or more.

We will usually try and book an appointment with the nursing team for removal of sutures at the same time as we book the procedure but this is not always possible.