1. Purpose
A dermatology service removes and biopsies skin lesions. Two things must not go wrong: the right lesion must be removed from the right patient, and the specimen must reach the laboratory, be matched to the patient, and the result acted on. A lesion excised but never sent, or a malignant result never seen, is a serious harm. This policy sets out how the Service carries out minor skin surgery safely and handles specimens and results so none is lost.
The Service must verify this policy against current British Association of Dermatologists and Royal College of Pathologists guidance before adoption.
2. Sources to verify before adoption
- British Association of Dermatologists, surgical and skin-cancer guidance: https://www.bad.org.uk/
- Royal College of Pathologists, guidance on specimen handling and request information: https://www.rcpath.org/
- National Safety Standards for Invasive Procedures (NatSSIPs): https://www.england.nhs.uk/patient-safety/natssips/
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
3. Scope
This policy applies to:
- minor skin surgery, including excisions, biopsies and curettage
- the handling of every specimen and the acting on every result
- the clinicians who operate and the staff who label, send and track specimens and results
4. Right patient, right lesion, right site
- the patient's identity is confirmed against the record using at least three identifiers
- the lesion to be removed is identified and marked before surgery, with the patient confirming it, so the correct lesion at the correct site is removed
- where a patient has several lesions, each is documented and, where more than one is treated, kept clearly separate through to the laboratory
5. Consent and the procedure
- informed consent is taken, covering the procedure, the likely scar, the risk of incomplete removal, infection and bleeding, and that the lesion will be sent for analysis
- the procedure uses an aseptic technique and the infection-prevention arrangements appropriate to minor surgery
- the procedure performed, the site, the local anaesthetic used and any complication are recorded
6. Specimen handling
Every specimen is handled so it reaches the laboratory correctly matched to the patient:
- the specimen pot is labelled with the patient's identifiers and the exact site at the time of removal, at the patient's side, before the next case
- where more than one lesion is removed, each goes in its own correctly labelled pot, with no risk of mix-up
- the request form gives the clinical details the pathologist needs, including the clinical suspicion
- the specimen is stored and transported as required and a record is kept of what was sent and when
A lesion that may be cancer is never simply discarded; it is sent for histology, or referred for the patient to be diagnosed by a service that will.
7. Acting on results: the fail-safe
The single most important step after surgery is that the result is seen and acted on:
- every specimen sent is logged and tracked until its result is back
- results are reviewed by a clinician, acted on, communicated to the patient, and recorded
- a result that does not arrive within the expected time is chased; the system does not rely on the result simply turning up
- a malignant or unexpected result triggers prompt action: further treatment, urgent referral, and clear communication with the patient
8. Wound care and follow-up
The patient is given clear aftercare advice, including wound care, the signs of infection, when stitches come out, and how to get help. The follow-up needed to give the result and any further treatment is arranged and recorded.
9. When something goes wrong
A wrong-lesion excision, a lost specimen, or a missed or delayed result is treated as a serious patient-safety incident: logged, investigated, with the duty of candour opened where the threshold is met, and the system changed to prevent a repeat.
10. Training
Clinicians performing minor skin surgery are trained and competent for the procedures they do, and staff who handle specimens and results are trained in labelling, tracking and the fail-safe. The Service records who is competent and the next refresher date.
11. Audit cadence
The Service checks, on a stated cadence, that:
- the correct patient and lesion were confirmed and the site marked before surgery
- every specimen was labelled at the patient's side and matched to the patient through to the laboratory
- every result was tracked, seen, acted on and communicated, with none outstanding unnoticed
- wrong-lesion, lost-specimen or missed-result events were investigated and learned from
The Registered Manager and the clinical lead review the results and record the improvement actions that follow.