Surgical dermatology

We have the facilities to provide operating services for both biopsy and treatment of skin lesions under local anesthetic. In addition to traditional skin surgery options we are also able to offer Mohs' Micrographic Surgery (MMS). This is a specialist technique used to treat some skin cancers of the head and neck as well as some more unusual skin cancers in other body sites.

Common surgical procedures include:

• Mohs' micrographic surgery

• Cyst removal

• Lipoma removal

• Mole removal

• Scar revision

• Skin cancer removal

• Skin tag removal

• Wart removal

Preoperative consultation
Before surgery you shall have ample opportunity to discuss your operation and its benefits and risks with your dermatologist. Depending on the lesion their may be a variety of non surgical options available such as cryotherapy, laser or photodynamic therapy. All options will be explored so you can make an informed decision on which treatment you would like.

The operation
During your surgery, your care and well being will be our main focus. All operations are performed in theatres equipped to the highest standards. 

Post-operative care
After your surgery, we will provide you with after care information and instruction on how to care for your wound. Patients with complex wounds are monitored closely, with nurse led wound checks and follow up with your dermatologist.

Surgery FAQs
Skin surgery, performed in expert hands, is relatively straightforward.  We work in CQC approved state of the art operating theatres, with top quality staff and equipment.  Throughout the procedure, the focus remains firmly on the patient's well being and comfort.  Here we provide on overview of some frequently asked questions, but if you need more information, please contact our team by messaging our nurse, or telephone for advice.

Will I need to stay in hospital?
Almost all patients are treated as "day-cases," which means that you can leave shortly after your procedure.  It's often a good idea to have a friend, family member or a taxi take you home.

Will I have a local or general anaesthetic?
Almost all skin procedures, even large ones, can be done under local anaesthetic.  A local anaesthetic is usually given as a simple injection to the area of skin on which we are going to perform the surgery.  It works very quickly and tends to last a little over 1 hour. Your dermatologist is highly skilled at local anaesthesia and the nurses are experts in looking after patients who are awake during the procedure. 

Occasionally, it may be more practical for you to be asleep during surgery.  If so, an anaesthetist can administer an general anaesthetic. 

Do you use dissolving stitches?
Sometimes! In our mission to give you the best scar, we use very high quality plastic/cosmetic grade stitches.  We favour dissolving stitches on certain body sites, such as the eyelid, mouth and genitals.  Elsewhere, we may favour non-dissolving stitches, or even tissue glue, or no stitches at all.

What about the scar?
At Skin55 Limited, our dermatologists take a real pride in our surgical scars.  We are interested in minimizing the appearance of your scar and will give you individually tailored care to help with the healing of your wound.  There is no such thing as scarless surgery, despite the claims of some practices.  We closely follow the scar research literature and apply the best available techniques.

Will I be left with stitch marks?
In our practice, it's rare for a patient to be left with stitch marks.  We frequently hide the stitches underneath the skin to avoid this problem, or we remove the stitches early to try to prevent stitch marks.

Mohs' Micrographic Surgery

Mohs surgery is a special method used to treat skin cancers predominantly located on the head or neck although other areas may be considered.  It was developed in the United States and is now becoming available in a limited number of locations in the UK.  The benefit of this method is that it minimises the amount of skin removed whilst maximizing the chance of successfully removing of the growth.

How is it performed?
The procedure is performed under local anaesthetic - the patient is awake and kept comfortable throughout. The dermatological surgeon removes the skin cancer, which is immediately frozen and processed by highly skilled technicians.  Within 20-30 minutes, the specimen can be analysed.  If there is evidence that there is still cancer left behind, the surgeon removes more, taking only very fine slices of skin, and the processing is repeated.  This process is repeated until the tumour has been fully removed.

How long does it take?
The whole process depends on the size of the skin cancer.  In many cases, we are able to clear the tumour at the very first attempt, but in other cases, more attempts may be required.  The important thing is that the tumour is completely removed by the end of the procedure. We advise patients to allow a full morning to clear the skin cancer and perform reconstruction.

Will I tolerate the surgery?
Almost all patients can tolerate Mohs surgery under local anaesthetic.  The nurses are highly caring and skilled at creating a relaxed atmosphere.  If you have any particular concerns or needs, these can be addressed at your initial consultation. 

How will the scar look?
In almost all cases, we are able to provide excellent results, even with large skin cancers.  We take a pride in the aesthetic appearance of our work and will make every effort to hide and minimize scars.  We also have a suite of lasers available to modify scars if required.  If you are being referred by an ENT, plastic or maxillo-facial surgeon, we can coordinate your treatment so that your referring surgeon can perform the reconstruction for you.

Will I need time off work?
We advise most patients to take a few days off work or to work from home if they are able to.  This depends on the site of the skin cancer - for example an eyelid skin cancer, once removed and reconstructed, may require and eye patch for a few days.  Detailed instructions and advice will be tailored to suit your needs at your consultation. 

What support systems do you have?
Patients are well supported by our nurse specialist who will guide you through the process and help you with any recovery questions that you may have.  If required, we can put patients in touch with psychological support services too. 

Benign lumps and bumps

Benign skin lesions (growths) are often referred to as “lumps and bumps.” A wide variety of these can be present on the skin, and most are amenable to treatment in expert hands. Most skin lumps are completely harmless, however some can help identify internal illnesses or genetic conditions, and others can be difficult to distinguish from more serious cancerous growths. Therefore, it is important to seek expert advice from a dermatologist regarding the nature of your skin lesion, and which is the best treatment, should any be required.

Cyst removal

This is one of the most common operations performed in the clinic. In many areas, cyst removal is no longer available on the NHS, leading patients to opt for private healthcare for their cysts to be removed. 

What is involved?
Our dermatologists specialise in removing cysts in the most aesthetic manner, with minimal scarring and inconvenience. All patients should come for an initial consultation to gain an idea of what is involved and preempt any aftercare issues. 

Most patients have small or medium sized cysts (up to 1.5cm) which can be readily removed under local anesthetic. This is done by making a small incision , about 5mm in length and carefully dissecting the cyst through a small hole, with a minimally invasive technique. The wound is then stitched closed (primary closure). 

Some patients with much larger or deeper cysts, several cm in size which can be treated by the same method. However, if the cyst is particularly deep or large, instead of stitching the wound closed on the day, it is packed with a dressing and allowed to heal for one or two weeks, before the final stitching of the wound (delayed or secondary closure). 

Primary vs delayed / secondary closure
The advantage of stitching the wound closed right away is that there is less aftercare involved. If the wound is packed with dressings and not stitched you will need to come for regular dressing changes before the wound is actually stitched closed. 

However, the disadvantage of stitching a wound at the time of operation is that blood, debris and tissue fluid collect in the space where the cyst was and become trapped under the stitches, leading to swelling, inflammation and possibly infection or leaking of the wound. 

In cases of larger, deeper cysts it is best to use the delayed closure method, but with small, superficial cysts, the primary closure method is suitable.