Patient's Guide to Dermatologic Surgery with Dr. Lewinson

Many lesions in dermatology require surgical removal, ranging from skin cancers, to atypical moles, to painful cysts or growths. Dr. Lewinson aims to provide patients with expert surgical management, with a compassionate approach dedicated to patient education and making informed choices on their treatment.

What to Expect on the Day of Surgery

While the surgical procedure itself is generally quick, Dr. Lewinson advises planning to be with us for at least 60 minutes on the day of surgery.

1. Arrival and Check-In: When you arrive, Dr. Lewinson's nursing team will warmly greet you and bring you to the clinic room. They’ll review the procedure to ensure you’re comfortable, answer any initial questions, and complete some paperwork. They’ll also take your blood pressure and pull up any relevant lesion photos or pathology reports.

2. Consultation with Dr. Lewinson: Dr. Lewinson will then meet with you to discuss the surgical plan in detail, explaining the procedure and any potential risks. He will also review alternative non-surgical options where appropriate. He’ll make sure all your questions are answered and that you feel fully informed and reassured before proceeding.

3. Anesthesia and Preparation: The nurse will carefully administer local anesthesia to numb the area. The anesthetic contains epinephrine, which helps reduce bleeding by constricting blood vessels; this takes a few minutes to set in. Once the area is fully numb, Dr. Lewinson will prep the site with antiseptics and drapes, ensuring a sterile environment.

4. Surgical Procedure: Dr. Lewinson will remove the lesion, taking a full-thickness section of the skin or more, if needed, to ensure complete removal. To close the wound, he’ll perform "undermining," a technique that loosens the skin to reduce tension on the wound edges. This helps achieve a better cosmetic outcome.

5. Closing the Wound: Dr. Lewinson will meticulously close the wound using dissolvable deep sutures and non-dissolving surface sutures, which typically provide a more aesthetically pleasing result. He will carefully control any bleeding throughout the procedure to keep the surgical site clean.

6. Dressings and Aftercare: After closing the wound, the nurse will apply dressings and provide detailed wound care instructions. A follow-up appointment will be scheduled for suture removal. Generally, the dressing should remain in place for 24 hours to protect the surgical site.

   
   

What to Expect After Surgery

The anesthetic will last about 3 hours, after which you may experience some aching or soreness, but significant pain is rare. Mild bruising, swelling, and some clear pink drainage are common for a few days. Ice packs (wrapped in a towel) can help reduce swelling and discomfort. If pain, drainage, or redness worsens, contact Dr. Lewinson’s office.

Later Outcomes

The scar may take up to a year to fully settle, but by 3 months, it will usually be mostly healed and often nearly invisible. During the first two weeks, the skin strength is around 20%, so it's important to avoid significant tension across the wound to support healing. Surgical excision specimens are sent for pathology review. Dr. Lewinson and his team will be in contact with you once results return.

Understanding the Risks

Dermatologic surgery is generally very safe, but as with any surgical procedure, there are potential risks to be aware of:

• Infection: Although rare, infections can occur. Dr. Lewinson follows strict sterilization protocols and uses techniques that help minimize this risk. His rate of surgical site infection is below the published average.

• Bleeding: Some bleeding from wound edges is expected, but deeper bleeding can result in hematoma formation. Dr. Lewinson reduces this risk by controlling bleeding with cauterization or tying off blood vessels during surgery.

• Damage to Adjacent Structures: Dr. Lewinson takes special care to avoid injury to surrounding tissues during surgery by using his advanced understanding of anatomy. It's important to know that if you are being treated for a skin cancer directly overlying a structure such as a nerve or blood vessel, it may not be possible to avoid it. This risk will be discussed with you prior to the surgery.

• Scarring or Poor Healing: While most scars heal well, infection, excess tension, surgery location and underlying health of the patient can affect the healing process. Dr. Lewinson's meticulous closing technique, expertise in biomechanics and post-operative care recommendations help improve the cosmetic outcome. Pulsed dye laser therapy may also be used to facilitate healing and minimize scarring.

Summary

Dr. Lewinson understands surgery can be a stressful experience for patients, and aims to mitigate this with a patient-centered approach by providing education, open communication and support throughout the process. If you require surgery to remove a skin lesion, Dr. Lewinson would be happy to assist.