UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Lipoma, Sebaceous Cyst and Skin Lesion Excisions
Effective Date: February, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed March 2008 May 2009 November 2011
PURPOSE: To provide guidelines for setting up and assisting with the removal of lipomas, sebaceous cysts
and skin lesions on a patient at UWMF clinics.
DEFINITION: The removal of a lipoma, sebaceous cyst or skin lesion, by means of excision using sterile
technique, to examine it for the presence of disease.
POLICY: The clinical staff will utilize the following guidelines to properly assist with the removal of lipomas,
sebaceous cysts and skin lesions on patients in the clinical setting at UWMF.
SUPPLIES: Provider’s order, Patient’s record, Permit for Operation, Sterile surgical tray, Skin hooks
(provider preference), 10cc syringe, Sterile specimen container (if sending for biopsy),
Local Anesthetic, 18G needle, 25G or 26G needle, No. 15 blade scalpel, Betadine or Chloraprep,
Sutures (provider preference), Cautery (provider preference), Tegaderm/steristrips/bacitracin
(provider preference), 2 set sterile gloves/gowns, Patient gown, Chux, Face shield
1. Check provider’s order and clarify any inconsistencies.
2. Wash hands and gather equipment.
3. Using sterile technique, open surgical tray and place any additional instruments on tray, as needed. Re-
cover tray until needed.
4. Introduce yourself and identify the patient. Include date of birth and verify allergies (specifically to
Betadine, Chloraprep, or local anesthetic)
5. Provide good lighting and provide privacy by closing curtains and door.
6. Room patient – Refer to Provider Preference List for Rooming Patients.
7. Explain procedure to the patient.
8. Following the provider’s discussion with patient, have patient sign Consent for Operation and sign consent
form as a witness.
9. Have patient change into a gown (if needed).
10. Assist patient to a comfortable position on the table.
11. Elevate table and adjust lighting.
12. Cleanse area well with Betadine or Chloraprep.
NOTE: Use alcohol if allergic to betadine or chloraprep. (provider preference)
13. Wash hands; and apply sterile gloves, face shield and gown (if needed).
14. Assist provider with procedure (as needed).
15. Remove sterile gloves and wash hands.
16. Assist patient to a comfortable position
Give patient “Post-op care for incision” handout
Review handout with patient
Give supplies (if needed)
Assist patient back to waiting room
Assist patient with follow-up appointment (if needed).
17. If sending sample for biopsy:
Place specimen in formalin container.
Label specimen, in presence of patient, with the following:
o Patient name and date of birth
o Specimen type
o Date and time of specimen collection
o Provider name
Complete necessary lab forms
Place patient sticker into Pathology log book.
Take labeled specimen container to the lab
18. Apply gloves and clean all surfaces with Dispatch
Bring surgical tray and instruments to dirty utility room
Place needles in sharps containers
Discard waste and disposable equipment in proper receptacles
Wash instruments and tray in dirty utility room
Remove gloves and wash hands
Bring instruments to clean utility room
19. Wrap surgical tray and instruments for sterilization in the clean utility room
20. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
the procedure performed, date & time completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how patient tolerated procedure
follow-up appointment (if any)
WRITTEN BY: Mari Mullen, R.N., Department of General Surgery
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: Kelly Meyer R.N., Department of General Surgery
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams &
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Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St.
Louis, MO: Mosby Elsevier.
Department of Surgery Date
Medical Director Date