A shave excision is a minor surgical procedure in which the GP removes a raised skin lesion superficially. The procedure is performed under local anaesthetic using a special flexible blade, called a Dermablade, or a surgical blade.
The skin lesion is not cut out deeply, so stitches are usually not required. A superficial wound remains at the treated area and heals naturally.
When can a shave excision be performed?
A shave excision is mainly suitable for small skin lesions that:
- clearly protrude above the skin;
- lie superficially within the skin;
- have been assessed as benign by the GP.
Examples include certain raised moles, seborrhoeic keratoses, skin tags and other small benign skin lumps.
A shave excision is usually unsuitable if:
- it is unclear what type of skin lesion is present;
- the lesion is flat, irregular or unusually pigmented;
- the lesion changes, bleeds spontaneously or does not heal;
- the lesion extends more deeply into the skin;
- complete removal and examination of the surgical margins are required;
- skin cancer is suspected.
In these situations, the GP may recommend an excision, a skin biopsy or referral to a dermatologist.
Initial assessment by the GP
Before a shave excision can be scheduled, the GP must assess the skin lesion during a regular consultation. The GP will consider the type, size, growth pattern and location of the lesion, as well as any changes or symptoms.
Together, you will discuss whether a shave excision is possible and medically appropriate. If the treatment is suitable, a separate appointment will be scheduled. The procedure will not usually be performed during the initial assessment.
Preparing for the procedure
Please tell the GP beforehand:
- whether you are allergic to local anaesthetics, disinfectants or adhesive dressings;
- whether you have previously experienced problems with local anaesthetics or wound healing;
- whether you have diabetes, vascular disease or a weakened immune system.
Blood-thinning medication usually does not need to be stopped for a shave excision. Never stop taking this medication without medical advice. The GP will assess whether any additional precautions are necessary in your situation.
You may eat and drink as usual unless you have been advised otherwise. Wear loose-fitting clothing so that the treatment area can be reached easily.
What happens during a shave excision?
You will lie or sit on the examination couch. The GP will check the skin lesion and may mark the treatment area.
The following steps are then taken:
- the skin is cleaned and disinfected;
- you receive a local anaesthetic injection;
- the GP checks that the area is sufficiently numb;
- the Dermablade is gently curved so that its sharp edge follows the surface of the skin, or an appropriate surgical blade is selected;
- the skin lesion is removed superficially;
- any bleeding is stopped;
- the wound is covered with a plaster or pressure dressing.
The local anaesthetic injection may briefly cause a stinging or burning sensation. Once the anaesthetic is working, you should not feel pain during the procedure. You may still feel touch, pressure or movement.
Minor bleeding can usually be stopped by applying pressure. The GP may occasionally use a haemostatic solution or cautery. Cautery uses heat to seal a small bleeding blood vessel superficially.
You can go home immediately after the procedure.
Examination of the removed tissue
The removed skin lesion may be sent to a pathology laboratory. There, the tissue is examined under a microscope to determine what type of skin lesion it is.
The GP will discuss whether laboratory examination is necessary and how you will receive the results. Results are usually available within two to three weeks.
After the procedure
The local anaesthetic usually continues to work for several hours. Once it wears off, the wound may feel tender. If necessary, take paracetamol according to the instructions on the packaging.
Always follow the individual wound-care instructions provided by the GP. The following advice will usually apply:
- leave the plaster or pressure dressing in place for as long as advised;
- replace the plaster if it becomes wet, dirty or soaked with blood;
- keep the wound dry initially;
- touch the wound as little as possible;
- do not scratch or pick at a scab;
- avoid swimming and bathing until the wound has closed properly;
- prevent clothing from rubbing against the wound;
- protect the treated skin from sunlight once the wound has completely closed.
The wound surface will usually be covered with new skin within approximately two weeks. Complete healing and fading of any discolouration may take longer. A follow-up appointment is usually not required unless the GP advises otherwise.
Scarring and possible complications
A shave excision usually leaves a small and inconspicuous scar. However, a lighter, darker, raised or slightly indented area may remain.
Because only the superficial part is removed, the skin lesion may sometimes partially return.
Other possible complications include:
- bleeding after the procedure;
- bruising or swelling;
- a wound infection;
- delayed wound healing;
- a change in skin colour.
When should you contact the practice?
A small amount of blood or wound fluid beneath the plaster is usually not a cause for concern. If the wound starts bleeding, press firmly on it with clean gauze or a clean cloth for 15 minutes without releasing the pressure to check the wound.
Contact the practice on the same day if:
- the wound continues to bleed despite applying firm pressure;
- the pain is clearly increasing;
- the skin around the wound becomes increasingly red, warm or swollen;
- pus comes from the wound;
- you develop a fever or feel unwell;
- you are concerned about the wound for any other reason.
Outside our opening hours, contact the out-of-hours GP service if your symptoms cannot wait until the practice reopens.
More information
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