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Minor Surgery

Local anaesthetic procedures to remove malignant and non-malignant skin lesions/moles etc, undertaken on an Outpatient basis.

MOLES

Moles are exceedingly common and usually well behaved. Unusual features such as CHANGE in size shape or colour may alert one to the need for a specialist examination.

WHAT ARE MOLES?
Moles are usually harmless collections of pigmented cells called melanocytes on your skin. They can appear alone or there may be many. We do not know why we have moles and mostly moles are harmless and don't require special care. 

WHAT IS A NAEVUS?
Moles are also called naevi; a single mole is a naevus. Most moles are present on the trunk, but they can also be on your face, arms and legs. Moles can be present in more obscure locations as well such as the scalp, under thenails and in the area usually hidden by underwear.

IS IT NORMAL TO HAVE MOLES?
Most of us have from 10 to 40 moles. New moles may appear up to the age of 30-40 years, but most appear by age 20. Some moles disappear with advancing age. It's especially important to become familiar with the moles on your skin because, in rare cases, they can become cancerous. Monitoring your moles and other pigmented patches, such as freckles and age or liver spots, is an important first step in reducing your risk of skin cancer — especially malignant melanoma, which may begin in or near a mole or other dark spot on the skin. Melanoma also can arise in areas of normal pigmentation. 

HOW DO WE RECOGNISE NORMAL MOLES?
Moles come in a wide variety of colours, shapes and sizes. They can be flesh-coloured,
brown, blue or black spots that vary in shape from oval to round. The surface of a mole
can be smooth or wrinkled, flat or raised. Over your lifetime, some of your moles are likely
to change. With exposure to sun, they may darken. They also may start out flat and brown in colour and later become slightly raised and lighter in colour. 

WHY DO MOLES CHANGE?
There are certain times in your life when moles may be more apt to change. During adolescence, for example, moles may darken and become larger. During pregnancy, women may develop numerous and darker moles. It is important to monitor your own moles for changes in size, shape, color, texture and sensation that may indicate a problem. These moles should be examined. 

ARE PARTICULAR TYPES OF MOLE MORE AT RISK?
Several types of moles have a higher than average risk of becoming cancerous. They moles that are larger than average — which is about 1/4 inch (6 millimeters) or the diameter of the end of a pencil— and irregular in shape are known as atypical (dysplastic) naevi. These moles tend to be hereditary. They are frequently described as looking like fried eggs because they usually have dark brown centers and lighter, uneven borders. Overall, they may look red or tan. If you have dysplastic naevi, you have a greater risk of developing malignant melanoma.

LARGE MOLES PRESENT AT BIRTH
Large moles that are present at birth are called congenital naevi or giant hairy naevi. These moles may increase your risk of malignant melanoma. In general, moles that are more than the size of an adult open palm pose the greatest risk. Any mole that was present at birth and is palm-sized or larger should be examined by an expert.

NUMEROUS MOLES.
If you have many moles larger than the end of a pencil you are at greater risk of developing melanoma

GANGLIONS

A ganglion is a cyst associated with a joint or tendon.

WHAT IS A GANGLION?
A ganglion is a cyst filled with clear jell-like material, related to a joint or tendon sheath.

WHERE ARE GANGLIA FOUND?
The commonest position for a ganglion is over the back of the wrist, but ganglia are also found on the front of the wrist close to the radial pulse, in the palm close to the base of the finger arising from the tendon sheath, and over the back of the finger at the end joint, where pressure often causes a groove to form in the nail.

WHAT CAUSES A GANGLION TO DEVELOP?
It is not fully understood why a ganglion develops, but it is thought to start with a degenerative (or ageing) process or injury in the capsule or ligaments around the joint, or the fibrous sheath around a tendon.

WHAT SYMPTOMS DOES A GANGLION CAUSE?
Usually a ganglion forms a smooth prominent lump which may fluctuate in size or even disappear completely, though it may come back again. Some ganglia are painful, especially small ones deep inside the wrist joint, which are difficult to feel.

WHAT TREATMENTS ARE AVAILABLE?
The time-honoured method of treatment involving a whack with the family bible is painful and risky. It is possible to empty the contents with a needle, but the material is viscous and complete emptying impossible, and the majority refill anyway. It can be a useful temporary measure and occasionally obviates the need for surgery. It is useful in deciding if excision is likely to relieve pain. Surgical removal is the definitive treatment.

WHAT DOES SURGERY INVOLVE?
It can usually be done under local anaesthesia, with numbing injections which avoid the need to be asleep. The ganglion is then excised in its entirety. Removal of a ganglion close to the nail involves tracing it down to the joint and removing a small bone spike in most cases, and there is often a shortage of skin, best treated by advancing skin from further down the finger, a rotation flap.

WHAT RISKS ARE THERE?
The scar is usually acceptable, but may become red and thick especially on the front of the wrist. Ganglia are known to recur on occasions, and this does not necessarily mean that they were incompletely removed, although incomplete removal may lead to recurrence. If a ganglion does recur it can be removed again, still with a good chance of success. As with all operations on the hand, there is a small possibility of unexpected stiffness, swelling or pain requiring physiotherapy or other treatment. This is an exaggeration of the normal response to injury or surgery.

For more information please see our Treatment Information Sheets

Moles

Ganglions