Complications of excision

Excision is a surgical procedure with potential complications like any other surgery. It is very important to understand the risks before you proceed with the excision. Ask the doctor or nurse if you have any concerns.

Scarring

Your procedure will leave a scar. Some lesions and some sites on the body scar more than others.

In most cases, there will be a red or pink mark at the site of the excision for several months. This is considered normal and it will gradually fade.

After that, there will usually be a fine line, or some times an oval-shaped mark which will persist long term.

The doctor will attempt to minimise scarring as much as possible, but you can help by not stretching the wound and taping it or applying silicone ointment.

Pain

Sometimes the local anaesthetic does not completely control the pain during the procedure. If this occurs, an extra dose of anaesthetic should eliminate any discomfort.

It is unusual to experience pain after a skin lesion excision as the wounds are usually quite small and shallow. If you do have pain, simple painkillers such as paracetamol or paracetamol/codeine should be sufficient. Avoid aspirin and ibuprofen as they might increase bleeding.

Pain occurring days after the procedure could be a sign of infection.

Bleeding and bruising

The doctor will minimise bleeding during the procedure, but in some cases there will be some bleeding afterward. This is more common when

  •  you are taking medication that increases bleeding, such as aspirin, warfarin, clopidogrel (Plavix) or fish oil
  • the wound is large or blood vessels were cut during the procedure
  • you are older (usually over 60)

If there is a risk of bleeding after the procedure, we will usually apply a firm bandage to apply pressure over your dressing.

It's very common for blood to appear on the dressing in the hours following a procedure, and in the morning if you have slept on the wound overnight. This is not necessarily a problem. However, if the dressing is soaked with fresh blood, you should consult a doctor.

Wound breakdown

The skin on each side of the excision site is held together by stitches while it grows together. If the wound is stretched too much, the stitches can break, causing the edges of the wound to pull apart. This can also happen even after the stitches have been removed, as the skin takes several months to reach maximum strength after an excision. 

This is usually an inconvenience and not a significant medical problem.

When a wound pulls open, the usual management is to let it heal from the bottom up without restitching it. The wound may need to be dressed repeatedly by a nurse, requiring multiple visits to the clinic. Most wounds heal well, but this process may take several weeks. Scarring is generally worse than it would otherwise have been.

You can reduce the chance of wound breakdown by avoiding stretching and heavy lifting for several weeks after the excision.

Infection

Approximately 5 per cent of excisions become infected. Signs of infection include:

  • pain and tenderness of the wound and surrounding area
  • redness spreading out from the wound
  • pus or an odour coming from the wound
  • fever

Most infections are minor and respond well to antibiotics, either oral or applied to the wound as a cream. However, if you think your wound is infected you must not use any antibiotics or medications you have at home. These might not be suitable for the specific bacteria that cause skin infections.

If you think your wound is becoming infected, a doctor or nurse should be able to assess the situation and recommend the best course of treatment.

Insufficient margins

When performing an excision, the doctor aims to remove the entire skin lesion with a margin of normal skin around it. By ensuring that there is normal skin surrounding the lesion, we can be sure that none of it remains behind.

The usual margin is 2mm at first, but sometimes after a lesion is confirmed to be a skin cancer, you need re-excision with a larger margin. For example, melanoma may require a margin of 5mm to several cm depending on its size and depth.

Sometimes the skin pathology result shows that the margins around the removed lesions aren't wide enough. When this happens, in some cases the wound might need to be re-excised.

Nerve damage

Damage to nerves is a rare complication of excisions. It occurs when the doctor cuts a nerve in the process of cutting out a lesion. In practice, nerve damage occurs almost exclusively when lesions are being removed from the face. If your lesion is in an area where nerves might be damaged, your doctor will discuss the risks before your procedure.