James A. Rieger MD -Board Certified Plastic Surgeon -Wichita,Hutchinson,Salina,Newton,Garden City,Dodge City Kansas
316-652-9333


Skin Lesion Removal Informed Consent                                            

 

This is an informed-consent document that has been prepared to help your plastic surgeon inform you concerning skin-lesion/skin-tumor surgery(s), its risks, and alternative treatment. It is important that you read this information carefully and completely.  Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon.

INTRODUCTION

The surgical removal of skin lesions and tumors is frequently performed by plastic surgeons.  Certain skin lesions and skin tumors will not disappear spontaneously; surgical removal is a treatment option.  There are many different techniques for removing skin lesions and skin tumors.  Your doctor will discuss the various surgical procedures involved in the removal of skin lesion(s) or skin tumor(s). There is no guarantee of any outcome. The goal is improvement not perfection. Satisfaction is based on realistic expectations.

ALTERNATIVE TREATMENTS

Alternative forms of management consist of not treating the skin lesion/skin tumor condition.  Removal of skin lesions and skin tumors may be accomplished by other treatments including the use of liquid nitrogen (freezing), lasers, topical medications, and electric cautery. Risks and potential complications are associated with alternative forms of treatment.

RISKS of SKIN LESION/SKIN TUMOR SURGERY

Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved.  An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.  Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and consequences of the surgical excision of skin lesions or skin tumors.

Bleeding- It is possible, though unusual, that you can have a bleeding episode during or after surgery.  Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood or require a blood transfusion.  Do not take any aspirin or anti-inflammatory medications for 2 weeks before and 2 weeks after surgery, as this may contribute to a greater risk of bleeding.  Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding.

Infection- Infection is unusual after surgery.  Should an infection occur, additional treatment including antibiotics or additional surgery may be necessary.

Scarring- All surgery leaves scars, some more visible than others.  Although good wound healing after a surgical procedure is expected, abnormal scars may occur both within the skin and the deeper tissues.  Scars may be unattractive and of different color than the surrounding skin.  There is the possibility of visible marks from sutures used to close the wound after the removal of skin lesions and tumors. Additional treatments including surgery may be needed to treat scarring.

Damage to deeper structures- Deeper structures such as nerves, blood vessels and muscles may be damaged during the course of surgery.  The potential for this to occur varies according to where on the body surgery is being performed.  Injury to deeper structures may be temporary or permanent.

Cancer- In some situations that a skin lesion or tumor that appears to be benign may be determined to be cancerous after laboratory analysis.  Additional treatments or surgery may be necessary. 

Recurrence- In rare situations, skin lesions and tumors can recur after surgical excision.  Additional treatment or secondary surgery may be necessary.

Unsatisfactory result- There is the possibility of a poor result from the removal of skin lesions and tumors.  Surgery may result in unacceptable visible deformities, loss of function, wound disruption, skin death and loss of sensation. You may be disappointed with the results of surgery.

Delayed healing- Wound disruption or delayed wound healing is possible.  Some areas of the skin may not heal normally and may take a long time to heal.  It is even possible to have loss of skin or deeper tissue.  This may require frequent dressing changes or further surgery to remove the non-healed tissue.

Smokers have a greater risk of skin loss and wound healing complications.

Allergic reactions- In rare cases, local allergies to tape, suture material, or topical preparations have been reported.  Systemic reactions which are more serious may occur to drugs used during surgery and prescription medicines.  Allergic reactions may require additional treatment.

Surgical anesthesia- Both local and general anesthesia involve risk.  There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.

Additional Specific Risks Relating to Skin Cancer Surgery

 

Systemic spread of skin cancer- Certain varieties of skin cancer can spread to other areas of the body.  Depending on the cell type and degree of invasion of the skin cancer, additional surgery or cancer treatment may be necessary. In some situations that involve melanoma-type skin cancer, patients may be advised to consider a sentinel lymph node biopsy staging procedure at the time of the excision of the skin cancer lesion.

Recurrence of skin cancer- Skin cancers in rare situations can recur after surgical excision.  Additional treatment or secondary surgery may be necessary.

Frozen-section inaccuracy- Frozen-section techniques used to determine tissue pathology and completeness of tumor removal may be inaccurate.  It is possible that subsequent tissue analysis may identify that there may be incomplete removal of the skin cancer or the presence of a different tissue pathology.  Additional surgery may be necessary if it is determined that the removal of the skin cancer is incomplete.

HEALTH INSURANCE

Health insurance companies may exclude coverage of certain procedures like this one and any complications that might occur from surgery  Please carefully review your health insurance subscriber information pamphlet and underwriting policies.

ADDITIONAL SURGERY NECESSARY

Should complications occur, additional surgery or other treatments may be necessary.  Even though risks and complications occur infrequently, the risks cited are particularly associated with this surgery; other complications and risks can occur but are even more uncommon.  The practice of medicine and surgery is not an exact science.  Although good results are expected, there is no guarantee or warranty expressed or implied on the results that may be obtained.

FINANCIAL RESPONSIBILITIES

The cost of surgery involves several charges for the services provided. This cost includes: surgeon’s fee, anesthesia fee, surgical center fee, office visits, and if applicable initial garment, implants, and overnight stay at the surgery center.  Prescription medications and any pathology are a separate expense and are not included in this quote. All costs arising directly or indirectly from surgery such as post surgical recovery longer than expected, inpatient hospitalization, complications, emergencies, transportation, ambulance, medical flights and  blood transfusion, if needed, are not included in these costs.  These and any other unanticipated fees and costs, including those not covered by insurance, are the responsibility of the patient.

If the procedures do not meet the patient’s highest expectations, and revision procedures are desired to achieve better results within the first two years, there may be, on a case by case basis, a reduction in the surgeon’s fee for the revision procedures.  However, the cost of the operating room, hospital, supplies, implants and anesthesia will be the responsibility of the patient.

DISCLAIMER

Informed-consent documents are used to communicate information about the proposed surgical treatment of a disease or condition along with disclosure of risks and alternative forms of treatment(s).  The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.  However, informed consent documents should not be considered all inclusive in defining other methods of care and risks encountered.  Your plastic surgeon may provide you with additional or different information which is based on all the facts in your particular case and the state of medical knowledge.

It is important that you read the above information carefully and have all of your questions answered before signing the consent.

 

                I have received, read and understand the following Informed Consent Material for my specific procedure:

Informed Consent For Skin Lesion/ Skin Tumor Surgery     

Medication and Smoking Avoidance Sheet

DVT prevention sheet

 

The risks, benefits, and alternatives of the procedure(s) were explained to me. I understand the specific risks in the consent material for my surgery and understand the significant risks of bleeding, loss of skin and tissue, further surgery if lesion not removed completely, return of the lesion or cancer in the future, wound problems, infection, injury to neighboring structures, capsule contracture(if implants involved), asymmetry, pulmonary emboli, deformity, healing problems, poor scars, loss of sensation(feeling), appearance/psychological  changes, unsatisfactory result, need for future revision surgery and anesthesia. I understand the anticipated results and limitations of the surgery procedure(s). I have realistic expectations and realize that there are no guarantees in plastic surgery. The following instructions were explained to me: Pre and Post procedure instructions, DVT prevention instructions, and medications to avoid instructions. I agree to follow all instructions, to follow up as directed, and to notify the office if any problems or questions arise.

 

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