Tophaceous gout is characterised by nodular masses of deposited monosodium urate crystals (MSU) due to untreated or partially treated hyperuricaemia with associated chronic inflammation and destructive changes in the surrounding joints and soft tissues. Tophi may be visible under the skin as yellowy/white nodules that are not tender to touch unless there are complications. Complications of tophi include intractable pain due to underlying bone and soft tissue destruction/deformity, compression due to mass effect (for instance, compression of peripheral nerves) and tophi breaching the overlying skin with loss of skin integrity, increased risk of infection of skin, underlying soft tissue, joint space or bone and occasionally chronic skin ulceration. Urate lowering therapy (ULT) at treat to target dosing can slowly reduce the size of tophi but may take several years in long-standing large tophaceous deposits. It is unknown exactly how prevalent surgical excision of tophi in people with gout is in the UK but is not thought to be commonplace and most likely confined to those patients with complications related to their tophaceous deposits. This review was carried out to assess the effectiveness of surgical excision of tophi.