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TEN TIPS...Minor Surgery

Nigel Stollery is a GP and dermatology clinical assistant in Kibworth, Leicestershire

1

It is always advisable to send specimens for histological examination, regardless of how confident you are of the diagnosis.

2

Excision is rarely successful for viral warts unless a very large margin is

taken. Recurrence

is common, making you unpopular if you advised excision.

3

In large seborrhoeic keratoses curettage and cautery is a useful and easily performed treatment. This can be made even easier by using disposable curettes.

4

A hyfrecator can be useful for skin tags. For larger tags local anaesthesia is needed, but for most smaller tags a low setting of

3-4 allows relatively painless treatment.

5

In general a mixture of local anaesthesia and adrenaline reduces bleeding by vasoconstriction in adjacent vessels, but should not be used where end arteries are present such as fingers, toes and the penis.

6

When excisions are small and the skin isn't under a lot of pressure, steristrips are an alternative to stitches. This also saves a nurse appointment as they can generally be removed by the patient at home.

7

Modern dissolvable sutures, although more expensive, are useful for areas such the genitals where removal of sutures may be embarrassing or inconvenient.

8

In these litigious days counselling about keloid scars is important, particularly among Afro-Caribbean

and younger individuals.

9

Following excisions on the back where the skin is under tension, the formation of larger scars is always a risk. Application of a strong fabric plaster across the line of most tension for a few months may help.

10

The risk of recurrence of BCCs is proportional to

the number of incomplete excisions of that lesion, so ideally all BCCs should be completely excised at the first

or second attempt.

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