Skin Surgery

Skin (dermatological) surgery

The Dermatology Treatment Centre is on the first floor of Glamorgan House where we offer surgical removal of skin cancers and Mohs micrographic surgery for certain skin cancers.  

Following your clinic appointment, we may recommend that you have a surgical procedure to diagnose/ remove/ treat a suspected skin cancer under local anaesthetic.
 

Preoperative Information

Before your procedure

Please avoid smoking two weeks before and two weeks after your surgery as it can impair healing and increase the risk of infection. Support is available here: Help Me Quit | Stop Smoking Services In Wales

Your regular medication: Unless we have advised you differently you should continue to take your regular medications as prescribed by your doctor.

If you take blood thinning medication, we should be made aware of this. We usually advise that you continue to take this as normal. You are at a slightly higher risk of troublesome bruising and bleeding after the procedure. If you are taking warfarin, then you should arrange to have your INR checked the week before the procedure and ensure it is in the target range. Please contact us if your INR is more than 3.

If you are due to have surgery on the head or neck, consider washing your hair the night before, or the morning of surgery.  You may not be able to shower for 24 – 48 hours after surgery.

On the day of your surgery, please ensure you eat and drink prior to the procedure. There is NO requirement to be starved for this surgery under local anaesthetic. Wear dark-coloured, comfortable clothes and do not apply any make-up if your procedure is on the face.

During your procedure

Your procedure will be carried out under local anaesthetic. The injections to numb the area can be a little uncomfortable but we aim for the rest of the procedure to be pain-free.

You can expect the procedure to take about an hour unless it is to be carried out under microscopic control (Mohs  micrographic surgery). In this case the procedure can be done in multiple stages and may well span an entire morning or afternoon.

After your procedure

Plan to have someone available to take you home after the surgery.  We advise that you do not drive yourself home after the procedure. We also recommend you are not alone for the first night following surgery.

We advise that you avoid any strenuous activity for the week following the surgery. This increases the risk of bleeding or infection or failure of any reconstruction. We advise avoiding alcohol consumption for a few days after your procedure.

If you have had stitches then these (unless dissolvable) are usually removed by the practice nurse at your local surgery one week after your procedure. If you have had complex surgery (eg. skin flap/ graft) then an appointment will be arranged for you one week after surgery in the Surgical Wound Clinic in the Dermatology Treatment Centre on the 1^st Floor of Glamorgan House so that the wound can be reviewed and the stitches removed.

You may need to be available for frequent follow-up or dressings appointments for 2-3 weeks (occasionally longer) following the surgery and you are advised not to make travel arrangements for this period.
 

Surgical Nursing Team

Mohs micrographic surgery

We are the only centre in Wales to offer Mohs micrographic surgery for skin cancer.

What is Mohs surgery?

Mohs micrographic surgery [named after Dr F Mohs] refers to the surgical removal of skin cancer using microscopic examination to ensure, as far as possible, that the skin cancer is completely removed.

When is it done?

Mohs micrographic surgery is not done as a routine procedure.  For most routine skin cancers, simple cutting out or scraping is appropriate.  The patients who come for Mohs micrographic surgery have been selected out as having unusual or more difficult tumours because of their type, size, location or failure of other techniques to produce a cure.

How does it work?

Your procedure begins in the morning.  The area around the skin cancer is numbed using local anaesthetic injection.  The affected area is scraped to help define the size and remove the obvious cancer.  Next the skin and tissue around the obvious cancer is removed with a scalpel.  This tissue is divided into smaller specimens which are prepared for examination.  A map of the cancer site is made, showing the relationship of the specimens which are then viewed under the microscope.  During this preparation of specimens for microscopic examination, a dressing is applied and you await the results in the procedure room or in the waiting room [usually 30 -90 minutes].

The Mohs surgeon then studies the specimens for the presence of cancer at the edges.  If cancer is still present then you will require further surgery to remove the area(s) of remaining cancer exactly as before.  The process is repeated until no remaining cancer can be found.

How long will it take?

Skin cancers may be present in skin, fat, muscle and less frequently nerves, arteries, cartilage and bone.  In more difficult cases, more time is required to remove all the cancer.  It is not uncommon to stay for the full morning and part of the afternoon and so consider bringing reading material and snacks. 

Some patients will require less time and some more.  You should plan no other activities for the day.  Remember, a larger portion of the time spent is waiting while your cancer is examined in the laboratory. 

What happens once the cancer is removed?

Once the skin cancer is removed, the surgical defect is attended to.  In most cases, the surgery to stitch up the wound is done immediately after removal and you return home the same day.  In larger or more difficult cases, arrangement may be made for any of the following: referral to another specialist for the reconstruction, admission to hospital or surgery requiring a general anaesthetic.

Laser

Our laser service is currently suspended due to the Covid-19 pandemic.

Missed appointments

If you are unable to make your appointment, please contact us (029 2184 8731) with as much notice as possible. If you miss your appointment or cancel with less than 24 hours’ notice you may forfeit your place on the waiting list.

If you require any further information to help you decide whether to go ahead with the procedure, then please contact the department prior to attending for the procedure appointment.

Dermatology Treatment Centre: 029 2184 8731 (answerphone)