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Surgical removal of moles, cysts, and skin tags remove

Moles, cysts, warts and skin tags can be quite common on the face and body. They are usually completely harmless and benign (non-cancerous) growths originating in the skin. Occasionally they may be unsightly or even painful, especially if caught when shaving, and these can be removed for cosmetic concerns or for comfort. Some lesions such as sebaceous cysts can also be prone to developing recurrent swelling and infections and may be removed for symptomatic relief.

There are several options to remove skin lesions. These include surgery, cryotherapy and ablative energy-based devices (such as lasers, radiofrequency or plasma energy).  The advantage of surgery is that the lesion can be sent for histopathological analysis as it is sometimes necessary to diagnose the nature of the lesion, and for reassurance that the lesion is completely benign. Certain lesions, such as sebaceous cysts, are also only optimally removed by surgery. Small skin tags and certain warts can, however, be simply removed using cryotherapy to freeze the lesion, causing it to undergo necrosis (die) and drop off. There is, however, increased risk of hypopigmentation (loss of skin pigment) particularly in darker skin types, as well as a higher risk of recurrence versus other treatment methods.

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Treatment Overview

work Skin lesion surgery: elliptical versus shave excision

Removing skin lesions by excision is a simple and straightforward procedure. Surgical options can be broadly divided into “elliptical excisions” (where the whole lesion is excised with a small margin of normal skin) or “shave excisions” (where the lesion is cut flush with the surrounding skin but not completely excised). The choice as to whether to excise a lesion as an ellipse or by shaving will depend on its location, size, shape, and patient preference.

The advantage of an elliptical excision is that the lesion is much more likely to be completely removed and therefore unlikely to reoccur. However, this technique will leave a scar that is typically 2-3 times the length of the lesion. In contrast, during a shave excision, the excision area is limited to the lesion only. Furthermore, the deeper layers of the skin are left intact allowing the skin to heal, usually, with almost no visible scarring. However, as the base or root of the lesion is not excised, there is a higher risk that the lesion will regrow (although this risk remains low).

Typically, in cosmetically sensitive areas of the face, a shave excision is often preferable but this again depends on the nature of the lesion and patient choice, as an elliptical excision may be more appropriate for some. Sebaceous cysts are removed by carefully dissecting out the deeper cyst sac intact together with a portion of the overlying skin containing the cyst opening (or punctum), either as an ellipse or very small circle. The wound is then closed in a similar fashion to standard elliptical excisions.

icon-needle How comfortable is the treatment?

Surgery for removal of a simple skin lesion is usually performed under local anaesthetic while you are awake. The local anaesthetic is injected into the area surrounding the lesion to cause localised numbing. Patients may experience some brief stinging or tingling for a few seconds as the anaesthetic is injected although the area will become numb very quickly. Sometimes a topical anaesthetic is administered to pre-numb the skin before the local anaesthetic is injected for even greater comfort (although this is not usually necessary). During the procedure, you should not feel any pain at all. You may, however, feel some pushing or pulling, which is entirely normal. Some patients actually fall asleep naturally during the procedure or listen to music.

natural-icon How are surgical excisions performed?

An elliptical excision, as the name suggests, involves excising the lesion with a margin of surrounding skin as an ellipse. The orientation of the ellipse, and therefore the scar, will depend on the lesion’s dimensions and location but is designed to run parallel with existing skin creases. The blood vessels are cauterised using diathermy to stop bleeding and then the wound is closed very neatly as a single line using sutures (“stitches”). Usually, the sutures will need removing in 6-14 days depending on where the lesion is (sometimes longer for lesions where the skin is often stretched and under tension such as the back). Occasionally, absorbable sutures may be used for the deeper layers or even on the skin surface, which will disappear by themselves.

A shave excision involves cutting the lesion as flush with the surrounding skin as possible (occasionally slightly deeper as a shallow saucer shape for pigmented lesions). We often use specialist blades as this tends to give better control of depth than a standard scalpel. As the skin is left intact, there is no need for sutures. There is also usually less bleeding than with an elliptical excision but sometimes gentle cauterisation is performed at the base of the wound.

icon-heart What post-operative care is required?

Following both elliptical and shave excisions, simple shower-proof dressings are applied and should be kept in place until your next appointment. After a brief stay in the recovery area, you will be discharged with specific aftercare instructions to follow at home. Post-operative antibiotics are not usually necessary but may be given under certain circumstances.  The local anaesthetic will wear off after 2-3 hours. You may experience some mild soreness and tightness for the first 1-3 days, which should be well controlled with simple paracetamol or ibuprofen. You will be given a date to return to the clinic for a wound check and, if applicable, for removal of sutures by the practice nurse.

results What are the after-care instructions for home?

Full post-operative care advice will be given and you will be able to resume your normal activities the same or next day.

Please keep the wound clean and dry to avoid infection while it heals. You can wash around the area but do not soak the wound in water, apply makeup until the wound has healed, or shave over stitches if they are in the beard area. If the wound is in an area of the body (e.g. back) where it might be stretched or under tension, avoid strenuous movements or exercise for 2-3 weeks after your operation.

The dressing may be slightly stained by some post-operative bleeding, but this is normal. If the bleeding persists, put a new dressing on top of the original one and apply pressure firmly for 20-30 minutes. If still bleeding after this time, please seek medical attention by contacting the clinic in the first instance, and do not remove the original dressing.

Surgery around the eye or forehead can sometimes result in bruising such as a black eye but will disappear after approximately one week. Lying on a few extra pillows at night will minimise any bruising.

icon-calendar When can you fly after surgery?

If you have an upcoming holiday or event, it is advisable to book a convenient appointment date to allow time for the wounds to heal or for any stitches to be removed. If you plan to go away, we usually recommend having surgery at least two to four weeks beforehand, depending on the lesion and procedure. More specific instructions will be provided at your initial consultation.

work What is histology or mole testing?

It is our policy to send all moles (and some other lesions) for histological analysis for reassurance and peace of mind. The specimen is sent to a laboratory where it is cut into multiple sections and each slide analysed under a microscope by a pathologist. Histological stains may also be used to look for specific cellular elements. Rarely, moles that appear clinically normal on the surface can have abnormal microscopic features deeper down. The only way to detect these changes is by histological analysis. Please note that, although we routinely send most lesions for histological analysis (except simple lesions such as skin tags or warts), we only remove lesions that are not clinically suspicious or worrying (i.e. only benign-looking) at the time of initial assessment.

icon-clock How long does the wound take to heal?

After an elliptical excision, a linear scar will form as part of the normal healing process. However, although initially red, this usually fades with time to an almost skin tone colour, this can take up to a year or sometimes even longer. After the sutures have been removed and any inflammation subsided, you can massage any facial scars with Bio-Oil® or moisturising cream twice daily for 3-6 months to improve scar tissue appearance. We recommend using a silicone gel such as Kelo-cote® for optimum results as this has been clinically proven to reduce scarring and protect healing wounds from UV damage caused by sunlight.

With shave excisions, there is very little scarring although there may be a scab which takes a few days to weeks to drop off. The same aftercare should be used as above making sure to keep the wound moisturised and protected from the sun using a broad-spectrum sunscreen with UVA filter. Certain individuals can develop hyper-pigmentation (where the skin becomes darker than the surrounding area). These are usually self-resolving although can take over a year to fade (but can be helped by using certain topical creams on a routine basis).

Sloave Clinic London
  • What are skin lesions?

    Moles are small coloured spots on the skin, formed when cells (known as “melanocytes”) producing pigment in the skin grow in a cluster. They are usually evenly coloured pink, tan, or brown and found above the waist on skin exposed to the sun. Most common moles are completely harmless.

    Warts are small lumps on the skin caused by the human papillomavirus (HPV). They feel firm and rough and can be itchy or painful. They are relatively harmless but are contagious.

    Cysts are non-cancerous, smooth lumps just under the skin that can be filled with fluid, pus, or other material. They are common and usually harmless though can become tender and sore if infected.

    Skin tags (acrochordons) are small growths on the skin that can look like warts but are made of loose collagen fibres and blood vessels. They are usually attached to the skin by a fleshy stalk (“peduncle”) and are skin-coloured or brown. Skin tags tend to grow in skin folds, such as on the neck, armpits, around the groin, under the breasts, on the eyelids or under buttocks folds. They’re very common and harmless but can snag on clothing or jewellery which can be frustrating.

    Other common skin lesions include freckles, birthmarks, lipomas and Actinic keratosis.

  • Which skin lesions can be treated with excision?

    We can treat the following:

    • moles
    • cysts
    • lipomas
    • keratoses
    • skin tags
    • other benign skin lesions

    We do not treat:

    • infected lesions – until completely healed
    • birthmarks, stretch marks or other marks  flat to the skin
    • Bartholin cysts
    • chalazion cysts on eyelids
    • ganglion cysts on wrist and hand
    • mucoceles inside lips
    • myxoid cysts on fingers
    • pilonidal cysts on the tailbone (coccyx)
    • rectal skin tags

    New moles or moles that change colour, size, and shape or become ulcerated, start to bleed or become itchy should always be medically-assessed in the first instance to ensure that they are not suspicious. Preferably, this is done by a dermatologist, plastic surgeon or specialist working as part of a nationally-recognised skin multidisciplinary team.

  • Are there any risks?

    Infection can develop in the wound and surrounding area. The risk of postoperative infection with skin lesion removal by surgery, however, is low but full advice on post-operative wound care will be provided. Signs to watch out for are if the wound gets more painful, red and inflamed, bleeds persistently or has a discharge or unpleasant smell. Although uncommon, any infection is usually well controlled with oral or topical antibiotics.

    Wound dehiscence is where the wound opens up as after an elliptical skin excision (by definition, this does not occur after a shave excision as the deeper skin layers are intact). This can occur after an infection or if the wound is put under a lot of tension. The management of wound dehiscence would again be to treat any infection before re-suturing (closing again using new stitches) the wound.

    Abnormal scarring can develop in some people and certain body areas. Scars may stretch, thin and widen (atrophic scars). Also, some people have an abnormal response to skin healing, and their scars can become raised and noticeable, even occasionally growing beyond the borders of the wound raised (“keloids” or “hypertrophic scarring”). There are however treatment options should this occur.

    Incomplete excision is a possibility, where the lesion is not completely removed (as microscopic elements of the lesion may remain behind that are not visible to the eye). Shave excisions have a higher risk of incomplete excision as the base of the lesion may remain intact (although this is usually cauterised to destroy any remnants). In the context of removing benign (non-cancerous) lesions, incomplete excision is not an issue unless the lesion regrows and becomes clinically evident.

    Recurrence of the lesion is possible, especially after incomplete excisions. However, even if the lesion is completely excised, it is possible for another lesion to grow in the same area.

    Very minor/small nerves may be injured during the incision, which can lead to some temporary numbness or pins and needles. This can last for some weeks or, occasionally, months until the nerves regrow but recovery almost always occurs. However, on rare occasions, a more significant nerve can be damaged that leads to permanent numbness or can affect the function of a muscle.

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