Informed consent: removal of a skin lesion

Removal of a cutaneous or subcutaneous lesion may be performed for diagnosis, treatment, appearance or comfort. Lesions may be benign or have malignant properties. The method depends on the lesion's size, base, appearance, location and whether malignancy is suspected. Removal always leaves some degree of scar.

Standard methods include surgical excision, with or without rapid histopathological assessment, followed by suturing. The removed tissue is usually sent for microscopic examination (histology). In some malignant facial tumors that have not been fully removed, the margins are examined during surgery by the Mohs method. Other methods include curettage and electrical cautery, laser, radio waves, liquid nitrogen or radiation. The method is selected according to the lesion and accepted indications.

In surgical excision, the extent of removal depends on the lesion. The wound is usually closed by bringing its edges together and suturing them. If this is not possible, a flap of nearby skin or a skin graft from another area may be used. The remaining scar may be up to three times the size of the lesion's base after primary closure, and larger after a flap or graft.

Sutures are generally removed within about two weeks, depending on the site. If the wound is left open, secondary healing usually takes several weeks. The appearance of the scar depends on the site, skin structure and individual healing response. Pathology findings may require a complex or repeat excision.

I confirm that I have been told about possible alternative treatments and the prospects, side effects and risks of each. The intended result is removal of all or most of the lesion and an explanation of the expected scar. The desired result may not be achieved, or may be partial, and further treatment, including repeat surgery, may be needed.

I have been told about accepted methods, their risks and prospects, related tests and procedures, their suitability for my lesion and the advantages of the selected method. With laser removal, pathological examination of the lesion is not possible unless its superficial part is removed with a knife.

I have been told that side effects after treatment may include bruising, redness, swelling, pain and discomfort. A scar will remain where the lesion was removed.

Possible complications during or after treatment include local bleeding or infection, opening of the sutures, failure of a flap or graft to take, prominent scars, pigmentation changes (loss or excess of color) and injury to peripheral nerves. In some locations, nerve injury may cause weakness or temporary or permanent numbness in or near the surgical area. These and other unlisted complications are uncommon.

I understand that treatment may need to be broadened or changed, or other unforeseen procedures performed, to save life or prevent bodily harm. I also consent to such steps when the hospital physicians consider them necessary during the treatment.

The form records whether anesthesia is general, regional or local. A combination is possible, with the final choice made together with the anesthesiologist. If general anesthesia is used, the anesthesiologist will explain it.

For local anesthesia, my consent includes its administration by the physician, with or without intravenous sedatives. Risks explained to me include allergic reactions of varying severity to anesthetic drugs. Sedatives can rarely affect breathing or heart function, particularly in people with heart or respiratory disease.

I agree to photographs before and after treatment for scientific purposes, such as conference presentations or scientific publications, and for documentation and follow-up.

I have been told about the importance of periodic follow-up with the surgeon or treating physician, as they determine, and of reporting unexpected changes during healing promptly. I confirm that I had enough time to consider the operation and consult people of my choice.

If the medical center has a university affiliation, students may take part in assessment and treatment under full supervision.

I understand that the procedure and related care will be carried out by designated staff under the institution's rules, unless a physician was selected and arranged in advance. No specific person has been promised for all or part of the care, which will be provided under the institution's accepted responsibility and the law. The physician in charge is recorded on the hospital form.

The operating physician may not be present at discharge. I consent to another physician carrying out discharge on their behalf.