1. Excision skin lesions, suspicious moles, skin cancers
Skin lesions should be considered for removal for symptoms of pain, bleeding, increasing size, history of infection, change in color or margins and for anxiety of possible skin cancer. Some risks include possible bleeding, bruising, infection, scar formation, wound separation, chronic pain or numbness, changes around the incision, anesthesia, and need for reoperative surgery for wider excision of cancer, drainage of infection or control of bleeding.
2. Excision cysts, skin masses, lipomas
Skin Mass: We all have lumps and bumps in our body. The typical reasons to consider surgery for removal include masses that are enlarging, painful, history of infection, hard nodules, rapid appearance of multiple lesions, and anxiety relief. Most small lesions that are superficial can be removed in the office under local anesthesia. Larger masses or deep lesions under fascia or muscle will require surgery in the operating room with either sedation and local anesthesia, or general anesthesia for both patient comfort and safety of resection in an adequate manner. Anxious patients or young children are often scheduled also in the operating room. Risks discussed include bleeding, hematoma, infection, scar formation, numbness and tingling around incisions, recurrence of lesions, anesthesia, and follow up procedures. All specimens are evaluated by pathology and we will call with the result or discuss in the office on return for a postoperative visit as necessary.
3. Drainage of skin abscess, cyst infections and direction of follow up wound care
Cyst Infection / Skin Abscess: Minor infections can on occasion be treated with antibiotic therapy alone. If successful the decision follows to monitor or schedule for an excision of the site to decrease risk of recurrence. For more severe infections an urgent excision and drainage/debridement is needed under local anesthesia in the office vs. outpatient with general anesthesia for severe deep or large infections. Wounds are then left open to heal by secondary intention (from inside out) by cleaning with quips' or packing with gauze to keep skin open till the inside heals and fills in the empty space occupied by the infection. Again the decision for excision in the future to decrease risk of reoccurrence is an option. Cyst infection can reoccur and unfortunately patients can get infection in cysts elsewhere. Risk for drainage include chronic pain or numbness around the incision, scar formation, anesthesia, persistent infection, need for repeat drainage should skin heal too quickly, bleeding and recurrent cyst infection.
Ultrasound Guided Needle Biopsies
1. Breast Lumps
2. Thyroid Nodules
3. Lymph Nodes
4. Soft Tissue Masses
Office local anesthesia works very well for small skin lesions, superficial masses and for deeper needle biopsy techniques. Many patients worry much more than they need to and are surprised it was not as uncomfortable as they were anticipating. We use a very tiny needle to inject the area and a buffered solution of local anesthesia know as "Sting Free". Injecting "Sting Free" there is a slight burn feeling, but much less than older solution. Patients with active infection / inflammation will experience more pain due to the underlying infection. Anesthesia at the hospital or surgery center will be recommended for large skin lesions, melanoma, masses that are large or deep or near vital structures. Anxious patients or young children are often scheduled also in the operating room.