Medical Oncologist
CION Cancer Clinics
Marking the surgical site: why it is done | CION Cancer Clinics
Before many operations, a member of the surgical team draws a mark on your skin to show exactly where the operation will be, and on which side. It is done while you are awake, so you can confirm it. The mark is one of several safety checks, repeated in theatre before surgery starts. This page explains how it works, when it is skipped, and what you can do. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why do they draw on your skin before surgery?
- How is the surgical site marked?
- What other marks might be made before a cancer operation?
- What do the words on the checklist mean?
- Is the site always marked?
- What do people often get wrong about site marking?
- Who is responsible for what?
- Common questions about surgical site marking
The short answer
Why do they draw on your skin before surgery?
The mark shows exactly where the operation will be done. A member of the surgical team draws it on your skin with a special pen while you are awake, so you can confirm it is the right place and the right side.
What the mark protects against
Many parts of the body come in pairs: two breasts, two kidneys, two arms, two sides of the neck. Operating on the wrong side is rare, but when it happens it cannot be undone. A clear mark, made with your help, is one of several simple checks that make that mistake far less likely. It is part of the safe surgery checklist used in many hospitals.
Why you are asked so many times
Expect to be asked your name, your date of birth, the operation and the side, again and again. The nurse, the surgeon and the anaesthetist each ask separately. This is not because they have lost your file. Each check is a chance to catch a mix-up before it matters.
What the mark does not tell you
The mark shows where. It does not show how big the cut will be, how much tissue is removed, or what the scar will look like. Those are questions for your surgeon at the consent meeting.
Do not wash off, scrub or cover the mark with cream. If it fades, tell the nurse so it can be redrawn.On the ward
How is the surgical site marked?
Checking who you are
A team member checks your wristband, your name and date of birth against your notes and your signed consent form. Answer out loud each time, even if it feels repetitive.
Agreeing the place together
You are asked to point to, or say, where the operation is and which side. If you cannot speak for yourself, a family member confirms it with the team.
Drawing the mark
A skin pen is used to draw an arrow, a line or initials on or near the site. It should still be visible after skin cleaning and once the theatre drapes are in place.
The final pause in theatre
Before the first cut, the whole team stops and confirms your name, the operation and the mark once more. This is often called a time out.
Not sure whether this applies to you?
Ask an oncologistOther marks you may see
What other marks might be made before a cancer operation?
Cancer surgery sometimes needs more than an arrow. Not every operation needs any of these. Ask your centre which ones apply to you.
Planning lines
For some breast, skin or reconstruction operations, the surgeon draws lines while you sit or stand, because the body changes shape when you lie down.
Stoma site marking
If you may need a stoma, an opening on the tummy for stool or urine, a nurse marks the spot in advance. They check it while you sit, stand and bend.
Why it matters
- Easier to see and look after
- Away from skin folds and belts
A marker for a lump that cannot be felt
A small lump found only on a scan may be marked beforehand by a radiologist, the doctor who reads scans. This can be a tiny clip, a thin wire or another guide.
Radiotherapy dots are different
Tiny permanent dots on the skin are used to line up radiotherapy. They are not surgical marks, and a surgical mark should never be drawn to look like one.
On your forms
What do the words on the checklist mean?
- Site
- The part of the body being operated on. The mark is drawn here.
- Side or laterality
- Whether the operation is on the left or the right. Written in full on your consent form, never as a short form.
- Consent form
- The paper you sign after the operation, its purpose and its risks have been explained. The site and side on it must match the mark.
- Time out
- The short pause in theatre before surgery starts, when the team checks your identity, the operation and the mark together.
- Wire or clip localisation
- A way of guiding the surgeon to a lump too small to feel, placed before the operation using a scan.
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Exceptions
Is the site always marked?
Not always. Some operations have no left or right, and some places on the body cannot hold a pen mark. In those cases the team uses other checks instead of a drawing.
Operations in the middle of the body
An operation through a cut down the middle of the tummy, or on a single organ such as the food pipe, may not need a side marked. The identity checks and the time out still happen.
Places a pen cannot mark
Inside the mouth, on the tongue or in other moist areas, ink does not stay. Teeth and some internal sites are also hard to mark. Your team may mark nearby skin, or rely on written records and scans checked together in theatre.
When it is an emergency
In a true emergency there may be no time for the usual marking on the ward. The checks move into theatre.
What you can do
If no one has marked you and you expected it, ask. If the mark looks like it is on the wrong side, say so at once. You will not offend anyone. A good team wants to hear it.
Commonly believed
What do people often get wrong about site marking?
"They are marking me because they are not sure what they are doing."
The mark is a routine safety step, done for many operations whoever the surgeon is. It adds a check. It does not replace the surgeon's knowledge of your case.
"The ink is dirty, so I should wash it off before theatre."
The pen is made for skin and stays on through the cleaning done in theatre. Washing it away means it has to be drawn again, and may delay your operation.
"The mark is the size and shape of the scar."
Usually not. An arrow or initials only show the place. Planning lines, where used, give a rough idea, but the final cut can change during the operation. Ask your surgeon what to expect.
"It is rude to question the doctor about the side."
You are part of the check. Speaking up is exactly what the process asks of you and your family, and teams expect it.
Shared checks
Who is responsible for what?
The surgical team
You and your family
Check your identity against the notes and wristband
Answer each time, and correct any wrong detail
Explain the operation and side on the consent form
Read it before signing, and ask if the side is unclear
Draw the mark while you are awake
Leave it on, and tell the nurse if it fades
Confirm everything again in theatre
Speak up at any point if something seems wrong
Questions we are asked
Common questions about surgical site marking
Who draws the mark before surgery?
Usually the surgeon doing the operation, or a doctor from the same team who will be in theatre. It is done on the ward or in the waiting area before you go in, while you are awake. For a stoma, a specially trained nurse often marks the site at an earlier visit.
Can I have a bath after the site is marked?
Follow the washing instructions you were given, but do not scrub the mark or put cream or oil over it. The ink is made to stay through a normal wash. If it fades or smudges, tell the nurse before you go to theatre so it can be redrawn clearly.
Does the marking pen hurt or stain?
It feels like an ordinary pen on the skin, and there is no needle involved. The ink usually fades over several days as you wash. If you have very sensitive skin or have reacted to skin markers before, tell the team so they can take care.
What if my father cannot speak or is confused?
A family member who knows the plan can confirm the site and side with the team. Bring the consent papers and any letters that name the operation. If there is any doubt, the team checks the scans and notes before marking, and again in theatre.
Why was I not marked for my operation?
Some operations have no left or right, and some sites, such as inside the mouth, cannot hold a mark. In those cases the team uses written records, scans and the time out in theatre instead. If you expected a mark and did not get one, simply ask why.
Is the mark the same as the cut the surgeon will make?
Not necessarily. An arrow or initials show the place, not the size of the cut. Planning lines give a rough guide, but surgeons may adjust during the operation. Ask your surgeon at the consent meeting how large the scar is likely to be and where it will sit.
The mark looks like it is on the wrong side. What should I do?
Say so straight away, to the nurse or any doctor nearby. Do not wait until theatre. The team will stop and check your consent form, notes and scans. Raising it is exactly what you should do, and nobody will think less of you for it.
Is a wire or clip placed on the same day as surgery?
It varies. A wire is often placed on the day of the operation, while a clip or other marker may be placed days or weeks earlier. The method depends on the lump and on what your centre uses. Ask your team which one you will have and when.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- World Health Organization — Patient safety
- NICE — Perioperative care in adults (NG180)
- Cancer Research UK — Surgery for cancer
- Macmillan Cancer Support — Surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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