PREOPERATIVE INSTRUCTIONS AND INFORMATION ABOUT YOUR SURGICAL PROCEDURE
I have scheduled you to have a growth excised in the office. Excision is the
medical term for removal of a lesion from your skin. The wound is closedwith stitches (deep ones that dissolve in 2 months) and superficial ones that
are removed in 7-14 days. The goals of the procedure are complete removal
of the growth and a good cosmetic result. Unless otherwise instructed takeall of your regularly prescribed medications and eat normally. After the
procedure most patients may resume their normal activities; sometimesthere are temporary restrictions on sports, exercising, lifting and other
Some tips on planning your procedure
Unless you have been told the procedure should be done ASAP don't
Near a major event (e.g. wedding, presentation, exam)
You cannot swim or go into a hot tub with a stitched wound
In most instances I will recommend that vigorous exercise be discontinuedespecially when there is a risk of sutures coming out and the wound falling
Anesthesia
We inject anesthesia that numbs the skin around the growth by affecting
local nerves. There is no significant absorption of the anesthetic so you arefully awake for the procedure. The discomfort of the injection is similar to
having blood drawn and lasts for 10-20 seconds. Once the skin is numb
(about 2-5 minutes) you will have no further pain from the procedure. In thevast majority of cases you will be able to drive yourself home, but it is
always wise to have a family member or friend with you for moral support. Cautions
1. You faint or pass out easily. If you do it's very important to eat 2
2. You have had difficulty with bleeding during prior surgical procedures. 3. You have a pacemaker.
4. You have an internal defibrillator device. 5. You are taking aspirin.
6. You are taking Coumadin or warfarin.
7. You are taking arthritis medications, anti-inflammatory drugs (e.g.
Motrin), persantine (dipyridamole), plavix.
8. You are taking vitamin E. 9. You require oral antibiotics before dental cleanings, have artificial
joints or artificial joints or artificial heart valves. Bleeding
There is always minor bleeding at the time of surgery which is very easilycontrolled. In rare instances there is delayed bleeding and the wound swells
and is painful (hematoma). In my experience the following minimizeexcessive bleeding at the time of surgery:
1. No alcoholic beverages for 2 days prior to the procedure (including
2. Aspirin. Please avoid taking aspirin for 14 days prior to your procedure
unless on a doctor's orders. If a doctor has recommended aspirin for
you, ask your doctor if it can be temporarily stopped and inform us of
the decision before the surgery date. Many things contain aspirin (e.g. Alka Seltzer) so read labels carefully. One aspirin can decrease your
ability to clot (thin your blood) for 2 weeks!
3. Motrin, Ibuprofen and other so-called nonsteroidal anti-inflammatory
drugs should be discontinued for 5 days. How come so much tissue needed to be removed?
In order to close an excised wound evenly as a thin line, the optimal lengthto width ratio is 3:1. Picture trying to close a circle from side to side; you get
two loops of tissue at either end and these need to be removed in order for
the wound to heal in a straight line. If you have a mole that is 6 mm wide(1/4 inch) and I excise it with margins of 2 mm (1/12 inch), this makes the
actual excision width 10 mm (5/12 inch). The length (3:1 length to widthratio) of the excision is 30 mm (1 and ¼ inches). Scarring When cut skin heals it always forms a scar. Every effort will be made to
minimize the appearance of the scar but certain locations (e.g. chest, around
a joint) are a higher risk for thicker or spread scars. If you form keloids ordon't heal well, please let me know. Postoperative care
We will give you detailed instructions after surgery is completed. If the
wound is in an area that you cannot reach please arrange for a familymember or friend to do the wound care for you. You will not be able to bathe
or shower the area for 24 hours. You will need Telfa (non-stick) pads,Vaseline and adhesive tape for the postoperative care. Discomfort Postoperative pain in most cases is mild, lasts less than 24 hours and can be
controlled with Tylenol. In some instances I will prescribe a narcotic for oneor two nights. Aspirin and Motrin should be avoided for 3 days. Questions or Concerns and Advice Surgical procedures can be intimidating so if you have questions or need
reassurance contact us! Our goal is to make your experience as smooth aspossible. Using a Walkman during the procedure is a helpful relaxation
PREOPERATIVE INSTRUCTIONS AND INFORMATION
Cautions
Scarring