Dermatology Surgery: what to expect


You are having a skin surgery for one of the following reasons:

  • You have an epidermal or pilar (scalp) cyst
  • You have a mole of concern
  • You have a skin cancer (basal cell cancer, squamous cell cancer, or melanoma)

Our surgeries are scheduled for Monday 8:30 to 3:30 and Friday 8:30 to noon.  The visit is scheduled for an hour, but much of this time is spent in checking in at the beginning to make sure you understand the diagnosis and procedure, ask questions, etc.; and in putting on the bandage and making sure you are all set at the end of the visit.

The procedure itself usually takes 20-40 minutes depending on the complexity of the repair.

You will be given a suture removal appointment at the end of the visit.

Stay on your aspirin, Coumadin or other blood thinner—but let us know you take it.

Let us know if you have allergies to pain medication, or injected anesthesia.

Tylenol is usually sufficient at controlling any discomfort following the procedure.

We seat you or recline you in a large surgical chair.

Dermatology surgery usually consists of cleansing the area with alcohol; numbing up the area in question with injectable lidocaine (Novocaine) with or without epinephrine (adrenaline); and applying a layer of iodine.

The spot in question is removed, usually with a “margin” to make sure it is removed completely.  The standard shape of the excision is a foot ball shape, which is necessary in order to make the sides match up without bumps (called dog ears) at the ends.  Sometimes a flap or graft is used if the location on the body does not have much skin or is close to an important structure such as the eye or mouth; bleeding is controlled with cautery or electric needle; and stitches are placed as an underlayer for strength (this layer is absorbed over approximately 2 months) and a top layer.

Stitches on the top layer are removed in 4-5 days if the procedure is on the face; in one week in most areas of the body, or in two weeks if the area is under a lot of tension.

A scar will occur with any surgery.  We try to minimize scarring by: making the scar longer and looser, to reduce tension; taking stitches out quickly; having you massage the area about 2 weeks after the surgery; using special dressings or steroid injection a month or so after the procedure, if necessary.

It is not uncommon for the underneath stitch to be pushed out like a little pimple, usually 1-4 weeks after the procedure.  This is harmless but if it concerns you, let us know.