Sussex minor surgery unit UK

Holbrook Surgery, Bartholomew Way, Horsham, West Sussex, RH12 5JL
Tel: 0844 815 1072 Fax: 0844 815 1073

Holbrook surgery is a purpose built modern Health centre with all the latest equipment for providing safe minor surgery. Of the seven doctors it is mainly Dr Jonathan Heatley and Dr Hwa-Lon Liu who do the minor surgery. They have been providing this for their patients for the last seven years under the NHS. However the NHS will no longer fund minor surgery that is not considered essential. If for instance someone has a small lump they want removed but it is not dangerous or likely to be cancerous GPs are no longer funded to do this work. However many patients want something removed for their own reasons and this clinic is to provide them with a cost effective safe service.

Dr Jonathan Heatley also does a lot of vasectomy operations using a new technique that makes the operation very painless and easy www.vasectomy.uk.net He has done the Cardiff Diploma in Practical Dermatology (DPD) and works on a regular basis in the local NHS dermatology department in Horsham hospital.

Dr Hwa-Lon Liu has a specialist interest in ENT, has the new ENT diploma and runs one of the first ENT clinics in general practice. (ENT=ear, nose and throat).

Holbrook surgery is in the north of Horsham a market town that lies half way between Guildford and Brighton. Built in 1997 it features a purpose built operating room and plenty of parking. Details of the surgery are available at www.holbrooksurgery.com

Instruments are sent to a central sterilising department at the local hospital for cleaning & sterilising. Many instruments are single use & disposed of after use. The needles used are bought in specially as the NHS only funds rather crude (and therefore painful) large sizes. Dental syringes are used to give greater control; all of which makes the local anaesthetic less painful. Further special techniques are used wherever possible to minimise discomfort. The Doctors make it a point of honour to make even the smallest of procedures as painless as it is physically practical.

We use the gentler fine dental needles for local anaesthesia (lower), rather than the larger NHS green needles (upper).

Ice can be used as a local anaesthetic for some procedures

Intradermal Naevi: These are the lumps that appear usually on the face and many have a few hairs growing out of them. The best operation for these is shave excision. The lump is raised up on a bleb of local anaesthetic then carefully shaved off flush with the skin surface. This gives a smaller flat pale scar that is barely visible.

Intradermal naevus on forehead	Shaving naevus off with scalpel
After removal	Healed up (1 month later)

Seborrhoeic warts: These are more common as you get older and are rarely seen under the age of 40. They form a rough and slightly greasy brown thickening and can get as large as an inch or two in diameter if left to grow. They can be removed by spraying with liquid nitrogen but this is a slow and not very effective method mainly reserved for multiple lesions. A more effective treatment is to scrape them off with a curette under local anaesthetic. The curette is like a very small spoon but with sharp edges. In fact these lesions often break up when rubbed by clothing and there is no harm in scratching them off with a finger nail although it would hurt somewhat!

Skin Tags: They start small usually around the neck or in the armpits and get more common and larger as you get older. They are easily snipped off with sharp scissors. As a local anaesthetic always stings a bit we find the best way to remove these is to press an ice cube onto them, then when cold and numb, quickly pick them up with forceps and snip them off. An alternative is to cover them with the surface anaesthetic EMLA cream which will work for something very superficial like this but not for the bulk of deeper lumps.

Ingrowing toenails: These cause misery and rarely get better by themselves. They usually occur in teenagers so we have become very adept at treating them with the absolute minimum discomfort possible. The best operation is called a wedge resection where about a fifth of the nail is cut away on both sides. The nail bed then has to be prevented from regrowing again as this would result in further ingrowing within a few months. To stop this happening the traditional method uses a chemical called phenol, which is applied into the nail bed on a bit of cotton wool for about 3-4 minutes. We have moved on from this rather crude method and now use an electrical method to prevent nail regrowth that results in a cleaner wound and faster healing.

Sebaceous Cyst or ”Wen”: This is a lump the size of a cherry under the skin usually on the back where the skin is thickest. It can occur elsewhere and Cromwell famously had a large one on his forehead! It is filled with a cheesy substance made of decomposed skin cells that smells pretty awful and if it touches the hands it takes a lot of washing to remove the smell. The cyst usually connects to the skin via a very fine pore and squeezing will extrude a small amount of the vile smelling contents. To remove it properly is quite tricky as it has a thin walled sack around it which must be completely removed otherwise it will recur.

Fibroma: These are the hard nodules that are most common on the legs. They often darken in colour to a reddish brown. They are the body scarring around an old insect bite. This is important because it is foolish to try to cut them out as the scarring can be severe. Instead they can be gradually rubbed away with pumice stone making them flatter and less obvious. Certain types of dangerous skin cancer can look a bit like these so it is important with a rapidly growing one to get it medically checked.

Basal Cell Carcinoma: These are usually treated on the NHS. However there is a very quick and easy way to get rid of small ones in elderly patients called double curettage and cautery. The lesion has to be less than 5mm diameter. It is then scraped out with a curette and the wound is cauterised with a hot diathermy tip. The wound is once more curetted out and cauterised. This takes a few minutes only and gives a cure rate of over 90%.

Mole removal and histology: This is available on the NHS at your local surgery if there is any suggestion the mole may be cancerous. However you may want an unsightly or knobbly mole removed and this is readily done by a number of techniques. If it is to be sent for histology then it needs careful removal by elliptical excision with suturing of the wound. Alternatively a mole that has been present unchanged for many years and that sticks up proud can be more easily removed with sharp scissors. Often these appear on the chest in men or women and are actually accessory nipples. It used to be thought of as a sign of a witch!

Thread veins: These are best treated by microsclerotherapy. We do not offer this service ourselves but a group of French vein specialists run a clinic at Holbrook Surgery and also in London. To find further details click on www.vanishingveins.com

Skin tags	£20- £60 depending on numbers
Intra dermal naevi	£30- £60 depending on numbers
Ingrowing toenail	£80 each nail
Seborrhoeic wart	£30-£80 depending on numbers
Sebaceous cyst	£60
Mole removal and histology	£100 each
Benign lumpy mole removal	£50 each

We pride ourselves on producing the absolute minimum scarring. However the human body is a very variable thing and neither we nor anyone else can give a cast iron guarantee that you may not get a scar. We know that some operations are almost guaranteed to cause scarring- see fibroma above, and we will give you an assessment of the risks in your particular case. There is a treatment for some scarring using steroid injections into the scar. Although we have never needed to do this for our own patients we can offer this to anyone unfortunate enough to have a scar they would like reduced.

This is the microscopic study of tissue to check whether it is cancerous. It is time consuming and expensive but essential for all suspicious lesions. We do not send skin tags and other obviously benign lesions off for histology unless specifically requested to do so.

This can be done most easily by telephoning Holbrook Surgery on 0844 815 1072 and asking for the private minor ops clinic. We also have a fax on 0844 815 1073 but would prefer you to phone.