What are the risks of surgical excision?

If you are preparing for surgical excision, it is normal to wonder what could go wrong as well as what the treatment is meant to fix. This guide explains the main risks, why they matter, and why most people still find the procedure straightforward and manageable overall.

Most risks are real, but usually manageable

Surgical excision is a well-established procedure used to remove skin lesions and skin cancers under local anaesthetic. It is generally safe, but like any skin surgery, it carries recognised risks such as scarring, bleeding, infection, pain, swelling, wound breakdown, and temporary or permanent changes in skin sensation.

The important thing is not to assume that risk means something is likely to go badly. In most cases, these risks are discussed because patients deserve a clear picture before treatment, not because serious problems are expected. Many issues, when they do happen, are minor and settle with proper wound care and follow-up.

Scarring is the most predictable risk

The one risk that comes with virtually every surgical excision is a scar. Royal Devon’s dermatology surgery leaflet says all skin surgery leaves a scar, and it notes that the scar is often around three times as long as the original lesion is wide because lesions are usually removed in an ellipse shape to help the wound close flat. It also explains that scars may be pale or darker than the surrounding skin and may become thickened in some people.

That does not mean every scar will be obvious long term. Dr Arif Aslam’s surgical excision page says scars usually improve over several months, and DermNet notes that wound remodelling and strengthening continue for six to twelve months after skin surgery. Even so, if you are prone to raised or keloid scarring, that is worth discussing before your surgical excision.

Bleeding, bruising, and swelling can happen

Bleeding is another recognised risk of surgical excision. Royal Devon explains that bleeding during surgery is controlled, but bleeding afterwards can still happen, especially if you are taking blood-thinning medication such as aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, or dabigatran. The same leaflet also notes that bruising results from bleeding under the skin, and surgery near the eye can sometimes cause a black eye.

Swelling is also common in the early stage after surgical excision. Royal Devon says some swelling is caused by the local anaesthetic itself and that inflammatory swelling from the surgery usually reduces after 24 to 48 hours. That is why early puffiness is usually expected, especially around the eye or lip, and does not automatically mean anything is wrong.

Infection and wound problems are important to watch for

Infection is one of the more important risks after surgical excision, even though it is still not the norm. Royal Devon says wound infection may occur despite preventive measures and is more likely in people who smoke, have diabetes, take steroids, or have poor general health. It also notes that lesions which were already ulcerated or crusted before surgery may carry a higher infection risk.

The problem with infection is not only discomfort. Royal Devon says infected wounds may gape or the stitches may fail, and scarring may be more pronounced afterwards. The same leaflet describes warning signs such as increasing pain, spreading redness, heat, puffiness, and weeping from the wound, while Cambridge’s aftercare advice also recommends seeking advice if symptoms worsen rather than improve.

Wound splitting, also called dehiscence, is another possible complication of surgical excision. Royal Devon says this is more likely in smokers, where the wound is under tension, after infection, or when the area is stretched by exercise or manual work. This is one reason aftercare instructions about rest and activity limits matter more than they sometimes seem.

Pain, allergy, and nerve-related changes can also occur

Pain after surgical excision is usually mild rather than severe. Royal Devon says pain is generally relatively mild and that more severe pain after the first 48 hours can suggest infection. Cambridge also says some soreness after the anaesthetic wears off is normal, which is why simple pain relief is often enough for most patients.

There is also a small risk of allergic reaction around surgical excision. Royal Devon specifically mentions possible allergies to local anaesthetic, latex, sticking plaster, and antibiotics. These reactions are not common, but they are important to mention before surgery if you have had any past problems with anaesthetics, dressings, or medications.

Finally, some people notice altered skin sensation after surgical excision. Royal Devon says nerves close to the lesion may be disturbed during surgery, leading to altered sensation or even muscle weakness in the area; this is usually temporary but can occasionally be permanent. DermNet also notes that complications of skin surgery can include delayed healing and larger scars if healing problems occur.

The balanced view

So, what are the risks of surgical excision? The main ones are scarring, bleeding, bruising, swelling, infection, wound splitting, mild pain, allergy, and temporary or sometimes longer-lasting changes in sensation. These risks are real, but they are also familiar, monitored, and usually manageable when the procedure is planned properly and the aftercare is followed closely.

If you are due to have surgical excision, the most useful next step is to ask how these risks apply to your specific lesion, body site, and health history. A specialist can explain what is typical in your case, what warning signs to watch for, and what treatment approach is most likely to give you a safe result and a good cosmetic outcome.