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Skin lesion removal

Skin lesions are lumps or bumps on your skin, such as moles, cysts, warts or skin tags. Most skin lesions are harmless and don’t need to be removed. But your doctor may recommend you have a lesion removed if it’s causing you significant problems, or if there’s any concern it could be cancerous. You can also have lesions removed privately if they’re bothering you or you don’t like the way they look.

There are many different types of skin lesion, including those listed below.

  • Moles are small, dark patches on your skin. You may be born with them, but they mostly develop when you’re a child or in your early adult life.
  • Keratoses are brown or pink scaly bits of skin that can appear anywhere on your body. There are several different types of keratosis. Some are related to sun exposure and have a small risk of developing into skin cancer.
  • Warts are small, rough lumps that are caused by infection with the human papilloma virus (HPV).
  • Skin tags are small, flesh-coloured bumps on your skin. They often form where your skin creases or gets rubbed (for example, on your neck).

Skin lesions aren’t usually removed on the NHS, unless you have one that’s causing you significant problems or there’s a chance it might be cancerous. If you want to have a skin lesion removed because of how it looks, you’ll usually need to pay to have this done privately.

If your GP has recommended that you have a skin lesion removed, they may be able to do it for you at your GP surgery. On the other hand, they may need to refer you to a dermatologist, especially if there’s any possibility that your skin lesion may be cancerous. A dermatologist is a doctor who specialises in identifying and treating skin conditions. If you need to have your skin lesion removed in hospital, it’s usually done as an outpatient procedure. This means you have the procedure and go home the same day.

There are several different ways to remove skin lesions, including chemical and surgical procedures (see ‘The procedure’ below). The type of procedure you’re offered will depend on the type of skin lesion you have and where it is on your body. For example, your doctor may advise you to have surgery if you have a skin lesion that shows any sign of turning cancerous. This type of procedure lets your doctor take out the lesion and send it to the laboratory for testing. Other types of treatment just destroy the lesion. Your GP or dermatologist will advise you on what treatment will work best for you.

It’s important to realise, especially if you’re having your skin lesion removed for cosmetic reasons, that the procedure will leave a scar. Your doctor will do their best to keep this scar to a minimum.

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Maria's mole
Maria’s always wanted to have the moles on her face removed.

Details

  • Preparation Preparing for skin lesion removal

    Your doctor will explain if there’s anything particular you need to do to prepare before you have your procedure.

    Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your chance to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.

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  • The procedure What happens during skin lesion removal?

    The technique that your doctor uses to remove your skin lesion will depend on various factors. These include how big it is, the type of lesion it is, and where it is on your body. Your doctor will advise you which method is most appropriate for you.

    Skin lesion removal is usually done under local anaesthesia. This blocks pain from the area and you’ll stay awake during the procedure.

    Techniques to remove a skin lesion include the following.

    • Partial removal (shave biopsy). This is a technique to ‘shave off’ lesions that stick out from your skin – such as skin tags, actinic keratoses and sometimes, moles. Your doctor will use a surgical blade to cut across the base of the lesion, leaving it at the level of your surrounding skin. This technique is often combined with cautery. This is when your doctor uses a device to apply an electrical current to your skin, which seals your skin and stops it from bleeding.
    • Complete removal (excisional biopsy). This is when the entire lesion is cut out. This technique is used to remove larger moles, and any lesions that your doctor thinks could be cancerous. Your doctor will use a surgical blade to remove the whole lesion, plus a margin of ‘normal’ skin around the edge. Your wound will need to be closed up with stitches afterwards.
    • Freezing (cryotherapy). This involves freezing off lesions with liquid nitrogen. It can be used to remove actinic keratoses, warts and skin tags. Your doctor will apply the liquid nitrogen to the area for around 10 seconds, using either cotton wool or a spray. A blister will form after the treatment, and the lesion will eventually fall off with the blister.
    • Scooping away (curettage). This method of removal can be used for warts. Your doctor will use a surgical instrument to gently scoop away the lesion. This technique may be combined with cautery (heat treatment) or cryotherapy (freezing).
    • Light therapy (photodynamic therapy). This is a technique that can be used to treat skin cancer, and lesions that may turn into cancer. It can only be done as an outpatient procedure in a hospital. Your doctor will apply a chemical to your lesion, before shining a special light on it. This activates the chemical and destroys the lesion.

    After your lesion has been removed, your doctor will usually apply a dressing to the wound.

  • Aftercare What to expect afterwards

    You’ll probably have local anaesthesia to remove your skin lesion. After a local anaesthetic it may take several hours before the feeling comes back. Take special care not to bump or knock the affected area, which might feel tender and sore.

    You’ll usually be able to go home when you feel ready. If you’ve had a sedative, you’ll need to arrange for someone to drive you home. Some people may prefer to have a friend or relative stay with them for the first 24 hours after a procedure like skin lesion removal.

    Your doctor or nurse will give you some advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

  • Recovery Recovering from skin lesion removal

    After having your skin lesion removed, your wound may take up to three weeks to heal.

    If you had non-dissolvable stitches to close your wound, your doctor or nurse will need to remove these after your procedure. Usually, this is after about seven days if the stitches are on your face, and 10 to 14 days if they are elsewhere on your body. The length of time dissolvable stitches take to disappear depends on what type you have. However, for most skin lesion removal procedures, they should usually disappear in about 10 to 14 days.

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.

    Your doctor may advise you to:

    • avoid stretching the affected area, particularly while the stitches are in and for two weeks afterwards
    • keep the wound dry for 48 hours and then clean it gently daily
    • keep the scar out of the sun until it's healed

    If the area where your skin lesion was removed gets increasingly painful, or becomes red and sore, see your GP. You could have an infection in the wound and you may need to have some antibiotics.

    Your scar may be red and raised at first. It will gradually fade over several months.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with skin lesion removal. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of skin lesion removal include:

    • pain
    • swelling
    • bruising

    All surgical skin lesion removal procedures leave you with a scar. How big and how noticeable this will be depends on the type of procedure you have and how much of your skin is removed. Ask your doctor about how much scarring to expect after your treatment. Most scars fade significantly over several months.

    Complications

    Complications are when problems occur during or after the procedure. Complications of having a skin lesion removed include the following.

    • Infection – you may need to take antibiotics to treat this.
    • Changes in your skin sensation, such as numbness, or a burning sensation. This can happen if nerves on the surface of your skin are damaged, but it's usually only temporary.
    • Unusual red or raised scars (keloids) – these may be unsightly and can be difficult to treat. See our FAQ below for more information.
    • Excessive bleeding – it’s usual for the wound to bleed a little after surgery, but occasionally it can be more severe.
  • FAQ: I've found a new lump on my skin, what should I do? FAQ: I've found a new lump on my skin, what should I do?

    Answer

    Most skin lesions, such as moles, cysts, warts or skin tags, aren't harmful. However, if you have a new mole or lump, or if an existing one has changed, see your GP to have it checked.

    Explanation

    Although the vast majority of skin lesions are benign, it’s important to remember that some skin lesions can be cancerous. Skin cancer is often painless and there are several types that can look different. Basal cell carcinomas (also known as rodent ulcers) often appear as a small, red, waxy or shiny lump. Squamous cell carcinomas often appear as a small pink lump with hard or scaly or crusty skin. Malignant melanoma is a form of skin cancer that usually starts as a dark spot or mole on your skin, or in an existing mole.

    Symptoms that may indicate skin cancer include any mole, spot, lump or patch that:

    • doesn't heal after four weeks
    • gets bigger, changes shape or colour
    • has an irregular edge
    • is patchy in colour or multi-shades
    • itches, bleeds or is crusty and scabbed for more than four weeks 

    These symptoms aren't always caused by skin cancer, but if you have them, see your GP.

  • FAQ: I have skin tags on my eyelids: can I have them removed? FAQ: I have skin tags on my eyelids: can I have them removed?

    Answer

    Skin tags, including those from near your eyes, can be surgically removed or frozen off with liquid nitrogen. Your doctor can tell you what would be best in your situation.

    Explanation

    Skin tags are small, flesh coloured bumps on your skin. They often form in places where your skin creases or where it gets rubbed (for example, your neck, armpits and groin). Skin tags are more common in obese people and are occasionally associated with other conditions such as diabetes. Pregnant women may be more prone to getting skin tags.

    Skin tags don't usually cause problems, but they may be particularly noticeable on your eyelids, so you may decide to have them removed. If you want skin tags removed for cosmetic reasons, you normally have to pay to have it done privately. Treatments include:

    • surgery – your doctor may cut skin tags off using surgical scissors
    • freezing with liquid nitrogen (cryotherapy) – your doctor may use forceps or a cotton wool tipped stick to apply the liquid nitrogen near your eyes 

    Your doctor will be able to explain your options and help you to decide which method is best for you.

  • FAQ: What are keloid scars? FAQ: What are keloid scars?

    Answer

    Keloid scars, also known as keloids, are scars that have over-grown the original wound and become raised, lumpy and are often red.

    Explanation

    Keloid scars form inside scar tissue. They happen when the collagen your body uses to repair your wound overgrows so that it looks like an exaggerated scar. This can happen soon after an injury or several months afterwards. Doctors aren’t sure why this happens but they know it’s more common in people with dark skin.

    Sometimes keloid scars can be painful, itchy or cause a burning feeling. Some people never get them, while others get a keloid scar after just an insect bite, acne (spots) or minor injury. Keloid scars can form on any part of your body, but are most common around your shoulders, upper chest and neck. Keloid scars won’t harm you and don’t turn into cancer.

    Keloids can be very difficult to treat. Treatment for keloid scars usually involves having steroid injections or applying a tape that contains steroids. Other treatments include:

    • liquid nitrogen (cryotherapy) to freeze keloid scars, which can help to stop their growth
    • laser treatment to lessen the redness, although this won't shrink the scar
    • silicone gel sheeting – although it’s uncertain yet how effective this treatment is
    • surgery – but your scar may come back bigger than before 

    You may be at risk of getting a keloid scar if you’ve had one before or if members of your family have them. With keloids, prevention really is better than cure. If you’re at risk of getting a keloid scar it’s best if you avoid piercings and unnecessary skin surgery such as cosmetic surgery. If you have acne, ask your GP about having treatment to reduce scarring.

    If you have any questions about keloid scars, ask your doctor for advice.

  • Resources Resources

    Further information

    Sources

    • Benign skin tumours. PatientPlus. patient.co.uk/patientplus.asp, published 19 August 2011
    • Melanocytic naevi. British Association of Dermatologists. www.bad.org.uk, published October 2013
    • Benign skin lesions. Medscape. www.emedicine.medscape.com, published 28 July 2014
    • Common warts. BMJ Best practice. bestpractice.bmj.com, published 9 October 2014
    • Skin tags. PatientPlus. patient.co.uk/patientplus.asp, published 15 October 2013
    • Seborrhoeic keratoses. British Association of Dermatologists. www.bad.org.uk, published September 2014
    • Minor surgery. Oxford Handbook of General Practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published date April 2014
    • Skin biopsy techniques in general practice. PatientPlus. patient.co.uk/patientplus.asp, published 15 July 2014
    • Cryotherapy. British Association of Dermatologists. www.bad.org.uk, published November 2014
    • Photodynamic therapy. British Association of Dermatologists. www.bad.org.uk, published September 2012
    • Excision of skin lesions. DermNet NZ. www.dermnetnz.org, published 13 December 2014
    • Actinic keratosis. BMJ Best practice. bestpractice.bmj.com, published 29 August 2014
    • Personal communication, Dr Michael Ardern-Jones, Associate Professor Consultant Dermatologist University of Southampton, 17 April 2015
    • Shave excision or curettage and cauterisation – wound care advice. Primary Care Dermatology Society. www.pcds.org.uk, accessed 27 January 2015
    • Care of the skin after cryotherapy. Primary Care Dermatology Society. www.pcds.org.uk, accessed 27 January 2015
    • Risks and complications of skin surgery. DermNet NZ. www.dermnetnz.org, published 29 December 2013
    • Skin cancer (non melanoma). Cancer Research UK. www.cancerresearchuk.org, published 9 September 2014
    • Melanoma in situ. British Association of Dermatologists. www.bad.org.uk, published November 2014
    • Skin tags. DermNet NZ. www.dermnetnz.org, published 15 December 2014
    • Keloids. British Association of Dermatologists. www.bad.org.uk, published July 2014
    • Keloid and hypertrophic scar. Medscape. emedicine.medscape.com, published 19 March 2014
    • Keloids and hypertrophic scars. DermNet NZ. www.dermnetnz.org, published September 2014
    • O'Brien L and Jones D. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews 2013, Issue 9. doi:10.1002/14651858.CD003826.pub3
    • Keloid. PatientPlus. patient.co.uk/patientplus.asp, published 28 April 2014
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    Reviewed by Pippa Coulter, Bupa Health Content Team, May 2015.

    Peer reviewed by Dr Michael Ardern-Jones, Associate Professor Consultant Dermatologist

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