UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Surgical Excision
Effective Date: October, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed Nov., 2007 June, 2008 May 2009 November 2011
PURPOSE: To provide guidelines for the set-up, assisting with and care of a patient undergoing surgical
excision at a UWMF Clinic.
DEFINITION: A surgical excision is the removal of cysts, moles, skin cancers and other growths.
POLICY: The clinical staff will utilize the following guidelines to properly set up, assist with and care for a
patient post a surgical excision.
SUPPLIES: Provider’s order, Patient’s record, Surgical Consent Form, Mayo Stand
Surgical pack, Lidocaine, Sterile gloves, Formalin container, Operand Skin Prep
1. Check provider’s order and clarify any inconsistencies.
2. Wash hands and gather equipment.
3. Introduce yourself, identify the patient and provide privacy.
4. Explain procedure to the patient. Provider will review consent form and clinical staff will witness patient
signing the surgical consent form.
5. Assist patient to a comfortable position.
6. Wash hands and open surgical pack on Mayo Stand, then apply sterile gloves.
7. Using sterile technique set-up Mayo Stand per provider preference.
Set-up disposable scalpel, fenestrated drapes, sutures and Hyfracator handle with sterile sheath and
tip, and surgical pack of instruments.
8. Position patient as required and place sterile drapes as indicated.
9. Cleanse skin and administer prescribed local anesthetic. (See Injections for Local Anesthetic).
10. Adjust lighting for procedure.
11. Assist provider, (as needed) with the procedure; ie: blotting, cutting sutures, retraction of wound etc.
12. At the end of the excision, (change gloves) provider will place tissue in proper container with label and send
to lab with appropriate lab form.
13. When provider is finished and incision is closed, clean and bandage according to “Dressing Site/Wound
14. When completed, remove gloves and wash hands.
15. Instruct patient regarding wound care. (See Dressing Instructions for Patients)
16. Document in the patient’s record:
Care given to the patient
Vital Signs (if taken)
Post care instructions given to the patient or family
Patient questions or concerns
Future appointments (if needed).
WRITTEN BY: Ronnie Peterson, R.N., M.S., Clinical Staff Educator
CONTRIBUTORS: Jodie Cook, Manager Dermatology
Lisa Hilker, CMA, Department of Dermatology
REVIEWED BY: Lisa Hilker, CMA, Department of Dermatology, 2011
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
Department of Dermatology Date
Medical Director Date