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Skin lesion excision
This procedure surgically removes a skin lesion from the hand or forearm, with a margin of surrounding tissue where required, so the specimen can be examined by a pathologist.
At a glance
Anaesthetic
Usually local anaesthetic or WALANT; occasionally general anaesthetic for a larger or more complex excision
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
One to two weeks after surgery
Driving
Usually fine once comfortable, unless a splint or dressing to the hand limits your grip
Post Operative Hand Therapy
Not usually required, unless the wound needs a skin graft or flap and scar management afterwards
Splinting
Generally needed if the excision is close to a joint, or a skin graft or flap is used
Pain relief
Usually simple pain relief such as paracetamol; stronger pain relief is rarely needed
Return to repetitive & heavy loading
Usually within a few days to two weeks, depending on wound size and location
Surgical excision of a skin lesion of the hand or forearm
The lesion is removed along with a margin of surrounding normal skin, and the specimen is sent to a pathologist to confirm the diagnosis and check that the margins are clear. If the diagnosis is uncertain, a biopsy may be taken first to guide further treatment. Depending on the size and location of the resulting defect, the wound may be closed directly, or may need a skin graft or local flap to cover it.
Who is this procedure for?
- A lesion that is suspicious for, or confirmed to be, skin cancer
- A lesion that cannot be confidently diagnosed on examination alone and needs tissue for pathology
- A benign lesion that is symptomatic, catches on clothing, or that you would like removed
- Not usually needed for a lesion confidently diagnosed as benign and not causing problems, which can simply be monitored
What does the surgery involve?
Local anaesthetic (or WALANT) is used for most excisions. The lesion is excised with an appropriate margin of surrounding skin, and the specimen is sent for pathology. The wound is then closed directly, or with a skin graft or local flap if the resulting defect is larger. Sometimes a wound is left open and planned to heal with dressings alone. A dressing is applied. Your results are usually available at your follow-up appointment, if not before.
Alternatives to surgery
Surgery is one option for a skin lesion of the hand. Depending on your situation, the alternatives may include:
- Observation: appropriate for a lesion that appears benign, with monitoring for any change over time
- Biopsy alone: taking a sample without full excision, to establish a diagnosis before deciding on further treatment
What happens if left untreated: a benign lesion generally causes no harm beyond local symptoms, but if a lesion is a skin cancer, delaying treatment allows it to grow and, for some skin cancers, to spread.
Dr Tomlinson will discuss which option suits your specific lesion at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital, or under local anaesthetic in rooms for some straightforward lesions.
How much time will I need to have away from work?
This depends on what your job involves and the size of the excision. Most people return to desk-based work within a few days. Manual or repetitive hand work usually needs a little longer while the wound settles.
When will I be able to drive again?
Usually once you are comfortable and any dressing does not limit your grip on the steering wheel.
When can I do a full day of administrative or desk work?
Often the next day or within a few days, provided the dressing does not interfere with typing or other tasks.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include a protective dressing cover, or reassigning tasks that need repeated use of the treated hand.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
Will I need a dressing or splint afterwards?
Most excisions need only a simple dressing. A splint is only needed if the excision is close to a joint or a skin graft is used.
Will I need to see a hand therapist afterwards?
Not usually, unless the wound needs a skin graft or flap, in which case a hand therapist can support scar management and recovery of hand function.
What pain medication will I need afterwards?
Usually simple pain relief such as paracetamol is enough. Stronger pain relief is rarely needed.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Incomplete excision, needing further surgery if the pathology margins are not clear
- A wound that needs a skin graft or local flap if the defect is larger than expected
- Altered sensation or a tender scar at the excision site
- Wound infection or delayed healing, which is uncommon
Anaesthetic
If you are having a general anaesthetic or sedation, your anaesthetist will discuss the specific risks with you beforehand. Local anaesthetic carries a small risk of an allergic reaction, bruising, or the anaesthetic not fully numbing the area, which can be managed on the day.
Recovery & rehabilitation
First 48 hours
Keep the wound dry and dressed. Elevate your hand if it is swollen
First week
Follow your dressing instructions and avoid heavy use of the hand
Second week
Sutures are often removed around this time if not dissolving, and pathology results are usually available
4 weeks
The wound is generally well settled and scar remodelling begins
3 months
The scar continues to soften and fade
Long term
A well-healed, flat scar is expected, though the final appearance can take several months to mature
Want to know more about skin lesion excision?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.