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Head & Neck Surgery

Mole Removal

Mole Removal

Mole or naevi or benign lesions are common. They can be from birth or occur with age. They are benign but in rare cases of pigmented naevi or atypical naevi there is a very small risk of cancerous changes. Some moles do resolve but most stay the same or get larger with time.

The main reasons for removal are

  • Cosmesis- unsightly on the face, multiple mole
  • Getting larger
  • Suspicious looking- atypical naevi, Spitz naevus
  • Previous history of melanoma
  • Bleeding from trauma

Non Surgical Treatments

Mole, naevi, benign solar keratosis, seborrhoeic keratosis or papilloma can be treated by

  • Cryotherapy (Liquid Nitrogen) - easy but a biopsy is not taken. Effective for solar keratosis and small superficial BCC and SCC in situ.
  • Shave excision- the lesion is shaved and allow to heal spontaneously. This may take 3-4 weeks. The deep aspect of the mole or lesion is still present and may recur again.
  • Curettage with diathermy - the lesion is scraped and the defect is cauterised. This usually leaves a small contracted white scar.

Surgical Treatment

Surgical treatment depends on the type of mole or lesion, size, site, depth and patient skin characteristic.

Options include

  • Excision - elliptical / simple, full thickness, wedge. The defect is then closed by re-suturing the edges together.
  • Serial excision – small portion of large mole (large congenital naevus) is excised and repeat a few weeks later until the entire lesion is remove. This result in a smaller scar.
  • Skin flap - the defect is repaired by moving tissue nearly (local flap) or from another region (regional flap). This is commonly very effective in the face.
  • Skin graft - split or full thickness – rarely use for benign lesion.

Anaesthesia

Simple cases can be treated under local anaesthesia and more complex cases are performed under sedation or general anaesthetic.

Dr Pham will discuss with you the best treatment option for your removal mole.

PREOPERATIVE (Before surgery) INSTRUCTIONS

  • Please cease Aspirin, Aspirin-containing products, Plavix and non-steroidal anti-inflammatories (such as Ibuprofen) for 10 days prior to and two weeks following your surgery. If you are on any medications that affect bleeding (such as Warfarin) please notify Dr Pham.
  • Smoking tobacco and alcohol increase anaesthetic and surgical risks. Please cease them for three to four weeks prior to and four weeks following surgery. They cause delayed wound healing, skin necrosis and other complications.
  • Please notify us of all your routine medications and significant health history. You can remain on your daily medications, except for blood thinners unless instructed otherwise.
  • Arnica, a natural herb that significantly decreases bruising, can be taken before and after surgery along with Vitamin C (ascorbic acid), which helps promote healing.
  • For general anaesthetic - if you are having a morning procedure you must not eat or drink after midnight the evening before. If you are having an afternoon procedure you must not eat or drink after 6.00am on the morning of surgery. You may, however, take your normal medications and brush your teeth.
  • Please shower and remove any make-up and nail polish before arriving for your procedure.
  • Unless you are remaining in hospital someone will need to drive you home after surgery and stay with you that evening.
  • If you have any concerns please call the office (08) 9380 4488. Remember, we are all here to give you the best possible care.

POSTOPERATIVE (After Surgery) INSTRUCTIONS

During surgery, dressings will be placed on the wounds. Wound swelling, bruising, tightness and pain are to be expected, especially in the first 2-4 days. You can shower normally after 1 day. Keep dressing tapes on for 3-4 days and remove then if the dressing starts to peel off or damp. Vaseline or antibiotic ointment (eg. Bactroban) as prescribed should be smear over the wound 4 times a day for 2-6 weeks. The wound is usually reviewed after 5-7 days. Most sutures are dissolvable and the remaining ones are removed at the first postoperative review after 1 week.

Medications

Dr Pham will prescribe pain relief to be used as directed. Usually Paracetamol +/- Codeine or Tramadol is sufficient. Most patients complain of discomfort rather than pain. Do not take additional pain relievers other than what Dr Pham suggests or prescribes and start any antibiotics when you get home.

Diet

You should take plenty of fluids and eat nourishing food as tolerated. You may feel nauseous for the first 24 hours.

Activity

You should rest for the entire day after major surgery. Sleep on your back with the head of your bed elevated or use two to three pillows for one week after surgery. Always protect your wounds from sun exposure. You can resume most daily activities the next day. You should avoid heavy lifting, exercise and activities such as running for 1-2 weeks after surgery. You can shower the next day. You can drive on the same day or 1-2 days depending on the surgery and type of anaesthesia used.

Most people can resume work after 1 day, but occasionally longer if patients prefer more privacy. Most swelling and bruising will subside after 2 -4 weeks.

Scars Management

Scars usually remain red and raised for 6-12 weeks. They will gradually fade and flatten. You can massage the scars with two fingers and should use moisturiser such as Vaseline, Bio-Oil or Vitamin E cream and sunscreen. Avoid direct sunlight for at least 6 months.

Final results following skin cancer procedures/reconstruction may take up to 3-6 months following surgery. You will need regular skin checks (every 6-12 months) either by your General Practitioner in some cases.

Please Inform Dr Pham's office or the hospital where the procedure was performed if you have the following:

  • High fever, chills or a temperature of more than 38 degrees
  • Heavy bleeding from the wounds
  • Severe pain or tenderness
  • Significant redness, or discharge around the incision

If you have any concerns, please contact Dr Pham's office on 9380 4488. Remember, we are all here to give you the best possible care.

Risks of Surgery

Modern surgery is safe but does have risks. Complications can occur despite the highest standards and world's best practice principles used by Dr Pham.

It is not possible to list all the risks but you should be informed of the common side effects and benefits so that you can make an informed consent. Dr Pham will discuss these in greater detail at consultation. You should write down any particular questions or specific concerns.

The potential risks are

  • General risk of surgery
  • Wound infection or breakdown - may require antibiotics
  • Bruising and swelling
  • Bleeding, blood clots or seroma
  • Chest infection
  • Sore throat from the breathing tube
  • Heart problems, blood clots (lower legs or lungs) or breathing difficulties due to anaesthesia and surgery in some patients
  • Scars that become raised (hypertrophic or keloid)

Specific Risks

  • Swelling and numbness
  • Painful or unattractive scarring including keloid and hypertrophic scars
  • Loss of skin graft or flap
  • Scar
  • Subjective dissatisfaction with the final outcome
  • Allergic reaction to sutures, tape adhesives and others
  • Incomplete excision - may require further surgery
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