Minor Surgery Service

You can only be referred to the minor surgery clinic after seeing a GP to diagnose your condition and assess suitability for surgery.  Unfortunately we are not able to perform procedures for cosmetic reasons on the NHS.  If there is any doubt that a skin lesion might be cancerous then we will refer you to hospital and you cannot be treated in primary care.

If the doctor feels a procedure will help you and the condition meets NHS criteria, the doctor will explain the procedure to you and the alternate management options.  If you are happy to go ahead for surgery you will be booked onto the minor surgery waiting list.

You will then be contacted by our reception team for a one stop surgery appointment.  During this appointment, the operating doctor will re-assess, discuss and ask you to complete a written consent form and then undertake the surgical procedure.

Operations are done 2  times a month by Dr Garrod.  He is ably assisted in theatre by our experienced Health Care Assistants.  For practical reasons, children cannot be present during procedures.

The operating doctor will explain the procedure to you.  You will have the opportunity to ask any questions about the procedure and when you are happy you will need to sign a consent form.  Most patients will be able to go about their normal business the following day but you are advised to ask somebody to drive you home.  All operations are performed under local anaesthetic (numbing of the affected area while the patient remains awake.)  We recommend that you rest in the waiting room for 15 minutes after having had your operation.

Commonly asked questions:

The final cosmetic result of the procedure cannot be guaranteed as every single patient has a completely different healing process as far as final scar appearance is concerned.  All procedures leave scars that are visible.  These may be keloid or hypertrophic.

Wound aspects - you will be given an aftercare advice slip with instructions about caring for the wound.  This is especially to avoid unwanted early openings which will result in an unwanted cosmetic result and wound infection.  There is a small chance that the wound might get infected and that this may require further treatment.

You are advised not to drive to or from the practice after surgery as the anaesthetic can make you feel unwell.  You might not be covered by your car insurance should you have an accident.

If you have any questions before or after the procedure then please speak to any of the clinicians in the surgery.

Common skin conditions that may be treated in the minor surgery clinic

In-growing Toenails 

It may be necessary to remove a portion of your toenail along with the underlying tissue (nail bed) to prevent that part of your nail growing back.  Prevention - To help prevent an ingrowing toenail, trim your toenails straight across. Don't curve your nails to match the shape of the front of your toe.   If you have circulation problems in your feet from disorders such as diabetes or peripheral vascular disease, see a chiropodist regularly to have your nails professionally trimmed.   Keep toenails at a moderate length. Trim toenails so that they're even with the tips of your toes. If you trim your toenails too short, the pressure from your shoes on your toes' tissue may direct your nails to grow into the tissue. Wear shoes that fit properly. Shoes that place excessive pressure on your toes or pinch your toes may cause your nails to grown into surrounding tissue. If you have nerve impairment to you feet, you may not be able to sense if your shoes fit too tightly. Take care to buy and wear properly fitted shoes, preferably from a shoe store specialising in fitting shoes for people with foot problems. Wear protective footwear. If your work puts you at risk of injuring your toes, buy footwear such as steel-toed shows, which protect your toes.

Sebaceous Cysts

These are harmless fluid filled sacs. They are very common and only need removal if they are catching or become infected or sore recurrently.  Sebaceous cysts originate from the sebaceous glands. These glands are generally located at the base of hair follicles and produce the sebum oil that coats your hair and skin. Cysts may form if a gland is damaged or if its duct becomes blocked. A sebaceous cyst may be only a few millimetres to more than 5cm in size. They can form anywhere on the body, but usually appear on the face, neck, or torso area. Lesions over 4cm may not be suitable for treatment in the GP surgery. Treatment of facial lesions will leave a scar which may be more cosmetically concerning that the cyst itself. 

A cyst that is inflamed or swollen can cause quite a bit of discomfort, but the inflammation is typically treated before the cyst can be removed.

Treatment options

No treatment is most appropriate if the lesion is not getting sore or infected. A total excision is an invasive procedure, but removes the entire cyst and eliminates its return. A minimal excision removes the cyst wall and its contents, requiring a smaller incision and minimizes the risk of scarring. Drainage is not an appropriate option in most cases as the cyst wall remains behind and will only refill again.

Seborrhoeic keratosis (aka seborrhoeic warts)

These are harmless warty spots that appear during adult life as a common sign of skin aging. Some people have hundreds of them. They NEVER become cancerous.

Treatment options for seborrhoeic warts

• Curettage and/or electro cautery
• Shave biopsy (shaving off with a scalpel)
• Ablative laser surgery (not available on the NHS)
• Cryotherapy (not available on the NHS)
• No treatment

All methods have disadvantages.  Treatment-induced loss of pigmentation is a particular issue for dark skinned patients.  There are no easy way to remove multiple lesions on a single occasion.  For more information  see: http://www.dermnetzn.org/lesion/seborrhoeic-keratosis.html

Operative methods Used

Electrocautery  

Many warts, moles, naevi and keratoses are removed with a scalpel and the base cauterised with the electrocautery. Alternatively skin tags can be removed entirely by this method which both cuts through the skin and also seals any small blood vessels simultaneously thus avoiding the need for any stitches.

Excision biopsy 

This is way that most skin lesions are removed. First, skin is infiltrated with local anaesthetic to numb the operating site. Skin is then incised and the lesion is removed and sent for histopathological examination. The wound is then closed by sutures (surgical stitches). Sutures are removed by a Nurse at approximately a week after the surgery. (The exact time depends on the site of the wound). The majority of patients who have this procedure do not have a lot of time off work. However, it does depend on the type of work that the patient does and the site and size of the lesion. Please contact the surgery in 3- 4 weeks to confirm that the histology report is back from your surgery and no further action is required.