Consent Form – Skin Surgery

Important information

Skin surgery is generally safe, however a small proportion of patients will experience one or more of the complications listed below. It is essential that you read the following carefully so that you can decide whether the potential benefits of the procedure(s) outweigh these risks.

Risks of skin surgery (Dr Lynch will tick relevant risks when you are asked to sign the form)

• Unsightly scar There will usually be a visible scar at the site of treatment. My goal is to give you the best cosmetic result possible and to hide the scar to the maximum extent possible, however the final cosmetic appearance cannot be guaranteed since it is also determined by the natural healing process. There is a risk that the scar may be raised or lumpy (including hypertrophic or keloid scar), depressed, different in color from the adjacent skin (redder/lighter/darker), or different in texture (for example more shiny) in comparison with the adjacent skin. There may be visible, permanent marks from the stitches. Surgery in a hair-bearing site will result in permanent hair loss within the scar. Rarely there may be fat loss beneath the scar resulting in more significant depression.
• Bleeding, bruising, haematoma formation There may be bleeding during the procedure and occasionally this may be substantial. Rarely there may be delayed bleeding hours or even days after the procedure. Rarely bleeding may occur under the surface of the skin leading to a large bruise or collection of blood that requires surgical removal.
• Infection There is a small risk of infection. In most cases this can be treated with antibiotics and the site will heal well. Very rarely there can be significant infection that results in the wound coming apart requiring a longer period of healing with dressings and more significant scarring or infection with uncommon organisms that is challenging to diagnose or treat.
• Blistering, crusting Blistering or crusting may occur at the site of treatment and this can persist for days or weeks.
• Pain There may be pain during the procedure or afterwards. Rarely pain may persist for a longer period or fail to resolve.
• Numbness / burning / altered sensation Any skin procedure can cause damage to the small sensory nerves that supply touch sensation. Usually this will improve with time but rarely it may be permanent resulting in numbness / burning / long lasting pain or altered sensation. Very rarely this can affect much larger areas of the body than the site of the surgery and can be permanent "regional pain".
• Pigmentary change The treated area may become hyperpigmented (darker), hypopigmented (lighter) or redder than the normal skin color. Rarely this may be permanent.
• Need for revision surgery There is a risk that you may need further surgery or other treatment to improve the appearance or to correct a functional deficit.
• Damage to important nerves and blood vessels Depending upon the site, there is a very small risk of skin surgery resulting in damage to important nerves or blood vessels that could result in permanent weakness, numbness or other serious adverse consequences.
• Delayed healing Rarely healing may not proceed smoothly and may take a prolonged period of time (weeks-months) with dressings needed. This is more likely in certain body sites such as the lower leg or nail but can occur at other sites. It is more likely if there is infection or other complications during the healing process.
• Allergic reaction There is a small risk of suffering an allergic reaction to local anaesthetic or to dressings applied. Very rarely this can be serious or life-threatening or cause permenent unsightly changes to the skin at the site of treatment.
• Wound dehiscence Stiches may fail to hold the wound together and it may come apart requiring a prolonged period of healing with dressings and leaving a larger scar. Risks are higher if there is infection or tension on the wound.
• Wound discharge or fluid collection There may be discharge of clear or blood-stained fluid from the treated site. Rarely this may continue for weeks and require dressings. Very rarely there may be a persistent collection of fluid under the surface of the skin that requires further treatment or surgery.
• Non-diagnostic result Occasionally the results of a biopsy are non-diagnostic and it may need to be repeated.
• Incomplete treatment / need for further treatment Lesions removed during surgery are often sent for pathological analysis. In some cases this may reveal that further treatment is required.
• Recurrence There is a risk that the treated lesion may recur.
• Suture granuloma If stitches are used occasionally there can be a reaction to one of the dissolvable deep stitches that is left in beneath the surface of the skin. This can occur after the wound has healed weeks-months after the procedure and cause inflammation, nodularity or discharge.
• Flap or graft failure If a skin flap or graft is used there is a small risk that this does not survive. If this occurs this will require a longer period of healing, can give a worse cosmetic result and may require revision surgery or laser treatments.
• Weakness / paralysis of the eyebrow or forehead Surgery in the temple area carries a small risk of damage to the temporal branch of the facial nerve. This can result in permanent weakness of the forehead on this side and dropping of they eyebrow giving an assymetrical apperance and loss of facial expression.
• Drooping / weakness of the corner of the mouth Surgery to the jawline carries a risk of injury to the marginal mandibular branch of the facial nerve causing permanent weakness or paralysis of the lower lip muscles, leading to an asymmetric smile and difficulty depressing or controlling the lower lip. This results in asymmetry, especially when speaking or smiling, and occasionally mild drooling or difficulty retaining saliva.
• Burning / numbness of the forehead or scalp Surgery of the forehead or scalp carries a small risk of damage to the sensory nerves that supply touch sensation to these areas. Damage can result in permanent numbness, pain or rarely a burning sensation that may persist.
• Distortion of the eyebrow Surgery of the forehead or the area near to the eyebrow carries a risk of distorting the position or appearance of the eyebrow causing an assymetric appearance. If a skin cancer is involving the eyebrow part of the eyebrow may be lost permanently.
• Hair loss Surgery of a hair-bearing site such as the scalp or beard area or surgery of the neighbouring skin carries a risk of permanent hair loss.
• Nasal distortion Surgery of the nose can result in a permanent change in the shape or appearance of the nose. There may be distortion of the nose, nasal blockage, nasal stuffiness.
• Eyelid/skin distortion, dry or watery eyes Surgery of the eyelid or adjacent skin can result in a pull on the eyelid "ectropion" which can be uncomfortable and unsightly. If it does not resolve it may need surgical correction. There can also be distortion of the skin with webbing, eyelid malposition, poor eyelid closure, dry or watery eyes, redness of the eye, ocular discomfort, and very rarely visual loss.
• Lip distortion Surgery of the lip and the skin adjacent to the lip can result in change in the shape or appearance of the lip, asymmetry, changes in lip movement that can affect appearance and facial expression. Some patients may also experience numbness, stiffness, drooling, or difficulty with speech or eating if muscle or nerve function is altered.
• Ear distortion Surgery of the ear can lead to change in the appearance of the ear, ear distortion, cupping of the ear, inability to wear glasses or hearing aid, persistent ear pain or reduction in size of the ear.
• Weakness of the shoulder Surgery of the neck can damage the spinal accessory nerve which is responsible for elevation of the shoulder. Injury results in permanent weakness of the shoulder and 'winging' of the shoulder blade.
• Dipping / contour change of limb Surgery to remove lesions on the arm or leg can cause a dipped "scalloped" appearance at the site of treatment due to removal of tissue and tension during suturing of the wound.

Fees and Samples

• In addition to the fee charged by Dr Lynch, there will be a separate fee charged by the clinic for use of the theatres.
• Unless otherwise stated, all lesions removed during skin surgery will be sent for pathological analysis and the clinic will charge a fee for this.
• All surgery can have complications that may require additional treatments. The costs of any additional treatments are not included in the procedure fees. These may be covered by medical insurance, but you should check this in advance.
• If you are self-funding, ensure you understand the fees payable to Dr Lynch and the clinic for theatre usage and any pathology prior to the procedure. If you are using medical insurance, you must have confirmation that they will cover all procedures and fees; otherwise you will be liable.
• You will always be informed of biopsy results, even if benign. If you have not received results within 2 weeks of surgery, contact the practice management team.

Aftercare

See the aftercare information for full details, some key points include:-

• Wound care: Usually a dressing will remain in place for 48 hours. You will then apply vaseline (from a new pot) several times per day to aid healing and prevent scabbing.
• Need to take time off work / activities / avoid travel: You will usually need to avoid exercise and/or work for a number of days after the procedure. Should a complication arise there is a risk you will need to take a longer period of time off work / normal activities. You should generally avoid long-distance travel for 2 weeks in case of complications arising.
• Stitch removal: If stitches are used to close the wound you may need to attend in 1–2 weeks time for these to be removed.