Consent: Excision of Lumps and Bumps

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

Excision of lumps and bumps refers to any minor procedure for skin or subdermal lesions, such as warts, moles, cysts or lipomas. These are typically undertaken under local anaesthesia in a day surgery unit.

The consent for all of these remains the same, with the slight caveat that all of these lesions have the potential to be cancerous (i.e. a simple mole may turn out to be a malignant melanoma) and require further resection of the borders to ensure optimum clearance.

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Bleeding Typically minimal blood loss occurs, however some lesions may be particularly vascular in origin. Use of local anaesthetic with adrenaline where possible will minimise the anaesthetic dose as well as aid in vasoconstriction.
Anaesthetic Risks The risks of local anaesthesia include intra-arterial injection and reaction to the anaesthetic. If performed under general anaesthetic, the risks include damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The patient will most likely have local anaesthesia during the operation and simple oral analgesics pain post procedure.
Bleeding There is a small chance of bleeding and bruising post operatively
Infection Superficial wound infection is possible, which may necessitate further washout and debridement or a course of antibiotics.
Scarring Any incision will result in a scar, which may form a keloid scar, particularly in high risk ethnicities.
Seroma A swelling of lymphatic fluid may occur in wound due to disruption of the lymph nodes and channels.
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.

This is rarely indicated in short-duration ambulatory surgery such as this.

Late

Complication Description of Complication Potential Ways to Reduce Risk
Recurrence Some conditions such as lipoma are likely to reoccur either in the same or an alternative location.
Further resection If the lesion is found to be malignant then further resection of the borders may be required to reduce recurrence rates.

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