Excision and Delayed Repair

INTRODUCTION:

This technique is most commonly used to treat Melanoma in-situ/ Lentigo Maligna, but it is also used to treat a number of other rare types of skin cancer. One of the major difficulties in excision of these tumours is that the edges are often difficult to assess with the naked eye. Standard excision may result in the tumour being left behind (incomplete excision). The technique of MSE overcomes this potential problem by allowing us to check the cancer has been removed before we close the wound.

BEFORE SURGERY:

Please inform us if you take medications which increase bleeding e.g. Aspirin, Clopidogrel (Plavix, Iscover), Warfarin, Xarelto or Eliquis as we may need to stop them or reduce dosage prior to surgery. Please take paracetamol, ibuprofen or a combination of the two if stronger pain relief is needed in this preoperative period.

Alcohol also aggravates bleeding so please avoid alcoholic drinks for 24 hours after surgery. Smoking reduces blood flow to the skin and slows healing. It would be helpful if you could stop smoking for a minimum of 3 days prior to surgery and for one week afterwards. Please inform us of any relevant allergies e.g. local anaesthetics, antibiotics, dressings, latex.

Please complete and return your Patient Admission Form as soon as possible to confirm your admission for day surgery and also to confirm your financial responsibilities prior to your admission.

THE PROCEDURE:

This method is used to overcome the difficulty in assessing tumour edges with the naked eye. The method is as follows:

1. The visible edges of the tumour are outlined and a margin is added around this. A photograph is taken. The tumour is excised under local anaesthetic. The wound is partially closed and covered with a dressing after bleeding has been stopped and the patient is discharged home.
2. The specimen is sent to the pathologist for examination.
3. One to three days later the patient returns at a time when the pathology report will be available. If the pathologist finds that the tumour has been removed the wound is repaired. This may require a flap or graft depending on the size and location of the defect. If the pathologist finds that the tumour has not been completely excised, further tissue is removed and steps 2 & 3 are repeated until the tumour is completely removed. Once the tumour is completely excised, the wound is repaired.

The overwhelming majority of tumours are removed with 1 or 2 excisions. During the period when the wound is covered with a dressing there should only mild tenderness. There is a small risk that the wound may ooze or bleed. Local pressure for 20 minutes with an icepack or a pack of frozen peas or beans is usually effective in controlling this problem.

The main aim of this method is to ensure complete removal and consequent cure of a potentially difficult and possibly fatal tumour.

POSTOPERATIVE CARE:

At the end of the final operation, the nurse will show you how to care for the wound and you will be given an instruction sheet to remind you how this is done. The stitches will usually be removed in 7 to 14 days–depending on the operation site.

There are usually 1-2 follow up appointments with our team after your surgery for these dressings and/removal of sutures and these appointments are included in the cost of the procedure. If you are unable to manage the wound care after these appointments, our nursing team can assist with regular wound care and dressings; there will be a cost for these appointments. We will advise of the cost of ongoing wound care appointments prior to this commencing as it will be dependent on the specific dressing requirements. Alternatively, we can refer you to a nursing service which can visit you at home and manage the wound care. Our nursing team can explain how this service works at the time of booking your surgical procedure.

Car parking is available under the Centre on the day of your surgery. A permit can be obtained from reception. You are advised to have someone drive you home after the procedure.

If you have any questions or problems during the course of your treatment please call:
Adelaide Skin & Eye Centre 8211 0000 (Monday to Friday 8am to 5pm).