Skin lesions are areas of skin that are growing abnormally, or look different to the normal skin surrounding it. There are many different types of benign (non-cancerous) skin lesions. They include the following.
- Moles – small, dark-coloured growths on your skin, which normally appear during childhood.
- Dermatofibroma – firm, raised growths that can be brown, purple or red in colour. You may develop a dermatofibroma after an insect bite or minor injury.
- Actinic keratosis – rough, scaly patches of skin, which develop on areas of your body exposed to the sun. Actinic keratoses have the potential to change into a type of skin cancer known as squamous cell carcinoma. Because of this, your doctor will usually recommend removing them.
- Seborrhoeic keratosis – grey, black or brown raised lesions that may appear on your body or scalp. They're more common as you get older.
- Keratoacanthoma – rapidly-growing lesions that have a solid, scaly core. They normally develop in areas of skin exposed to the sun. Keratoacanthomas can look very similar to squamous cell carcinomas, so they usually need to be removed to confirm the diagnosis.
- Skin tags –small, flesh-coloured bumps on your skin. These are very common, and often form where your skin creases or gets rubbed (for example, on your neck or in your armpits).
- Pyogenic granuloma – these are small, bright red nodules that often develop after an injury. They tend to bleed easily, and it's often recommended that they're removed.
- Sebaceous cysts – round, fluid-filled lumps, which range in size from a few millimetres to several centimetres. They can become infected.
- Warts – small, rough lumps that are caused by infection with the human papilloma virus (HPV).
You should see your GP if you notice any new changes to your skin, especially if it's a change in the size, shape or colour of a mole
Your GP will recommend you have a skin lesion removed if there is any suspicion that it could be cancerous, or could become cancerous. Some benign (non-cancerous) skin lesions look very similar to skin cancer. The only way to tell for sure whether or not it's cancer is to have the lesion removed and examined in a laboratory.
Skin lesions that have no signs of being cancerous don't need to be removed. If a skin tag, mole or other lesion is causing you significant problems though, for instance it's catching on clothing, you may prefer to have it removed.
You may also decide you want a skin lesion removed if you're unhappy with how it looks. But if you're having it removed solely for cosmetic reasons, you'll usually need to pay to have it done privately. It’s also important to realise that many of the procedures are likely to leave a scar. Your doctors will do their best to keep the scar to a minimum, but it may end up bothering you almost as much as the original lesion.
Your GP may be able to remove your skin lesion for you at your GP surgery or prescribe you a cream or gel to use at home. For some types of skin lesion, especially those that may be cancerous, your GP will need to refer you to a dermatologist. A dermatologist is a doctor who specialises in identifying and treating skin conditions.
Skin lesions can be cut out, frozen off, treated with special creams, or destroyed using heat, laser or light therapy. What treatment you’re offered will depend on the type of skin lesion you have and where it is on your body. Your GP or dermatologist will advise you which method will work best for you.
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.
Techniques to remove a skin lesion include the following.
Complete excision (excision biopsy)
This is a type of skin biopsy, in which the whole skin lesion is cut out and removed. It's the standard way to remove a lesion where there is any possibility that it might be cancerous. You'll usually have a local anaesthetic before a skin biopsy, which will block any pain. Your doctor will then use a surgical blade to remove the whole lesion, plus a margin of ‘normal’ skin around the edge.
Your doctor may use adhesive strips or a special type of glue to close smaller wounds or stitches for larger wounds. They'll then apply a plaster or dressing to cover the wound.
Partial removal (shave biopsy)
A partial removal, or shave biopsy, is a technique to ‘shave off’ lesions that stick out from your skin – such as skin tags and seborrhoeic keratoses.
Your doctor will cut across the base of the lesion, leaving it at the level of your surrounding skin. This technique is often combined with cautery, which uses heat therapy to seal your skin and stops it from bleeding.
Creams and gels
Your doctor may be able to prescribe a cream or gel containing medicines such as imiquimod, salicylic acid, 5-fluorouracil or diclofenac that can get rid of a wart or actinic keratosis. You'll usually need to apply the cream or gel every day for up to several weeks.
Heat treatment (electrocautery)
With this treatment, your doctor will apply a heated coil to the base of your lesion to remove it. Electrocautery can be used to remove skin tags and is often used in combination with other techniques to stop any bleeding.
This involves freezing off lesions with liquid nitrogen. It can be used to remove actinic and seborrhoeic 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 this will fall off around one to two weeks after the procedure – or sometimes longer.
Scooping away (curettage)
This method of removal can be used for warts, pyogenic granuloma, actinic keratoses and seborrhoeic keratoses. Your doctor will use a curette "spoon" to gently scoop away the lesion. This technique may be combined with electrocautery (heat treatment) or cryotherapy (freezing).
Your doctor may recommend using treatment with lasers if you have a wart, a dermatofibroma or an actinic keratosis patch on your lips.
Light therapy (photodynamic therapy)
This is a technique in which a special light is used to activate a chemical applied to your lesion in order to destroy it. Your doctor may recommend light therapy if you have actinic keratosis.
You’ll usually be able to go home as soon as you feel ready. 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 and to have any stitches taken out.
If you've had a local anaesthetic to remove your skin lesion, it may take an hour or two before the feeling comes back. Take special care not to bump or knock the affected area, and don't have hot drinks if you've had anaesthetics around your mouth. Your wound may feel tender and sore after the anaesthetic has worn off.
If you've had a surgical procedure, such as a skin biopsy or curettage, it can take up to three weeks for your wound to heal. Your doctor or nurse will tell you when you'll need to have your stitches removed, but it's usually within 14 days.
It normally takes a couple of weeks, or occasionally longer, for a lesion to scab and come off after cryotherapy. Your skin will usually look completely normal after this. People with darker skin may notice their skin looks lighter or darker in colour, but this normally improves with time.
After photodynamic therapy, it'll take a few days for a scab to form, and can take several weeks to heal.
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.
Looking after your wound
Your doctor or nurse will give you specific advice relating to the type of procedure you've had. But it might include asking you to:
- avoid stretching the affected area, particularly if you've had stitches
- keep the wound dry for 48 hours, or until any dressings have been removed, and then to clean it gently daily
- avoid picking any scabs that form (eg after cryosurgery or photodynamic therapy), or doing anything to accidentally dislodge them
If the area where your skin lesion was removed gets increasingly painful or becomes red and sore, contact the doctor who performed your procedure. You could have an infection in the wound, for which you may need treatment with antibiotics.
Complications are when problems occur during or after the procedure. Complications of having a skin lesion removed include the following.
- Infection – you can develop an infection after many skin lesion removal procedures, including biopsy, curettage, cryotherapy and photodynamic therapy. Signs of an infection include the affected area becoming increasingly painful, red or sore. You may also notice a discharge or pus. Contact your doctor if this happens; you may need to take a course of antibiotics.
- 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.
- Your skin looking lighter (hypopigmentation) or darker (hyperpigmentation) – this can happen as a result of cryosurgery or another type of surgery. The affected area of skin will be more prone to sunburn, and you'll need to use sunscreen to protect it. Your skin may also become darker or lighter after photodynamic therapy.
- 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 – if you're having a biopsy, it’s usual for the wound to bleed a little after surgery, but occasionally it can be more severe. If this happens, there are a number of techniques your doctor will use to stop the bleeding. These include applying firm pressure to the wound, injecting a special agent into the wound to stop bleeding, and stitching any blood vessels.
Side-effects are the unwanted but mostly temporary effects you may get after having your skin lesion removed. The exact side-effects you might have will depend on what type of treatment you're having, but it's common to have some pain, inflammation and swelling after many of the treatments and procedures.
All surgical skin lesion removal procedures, including biopsy and curettage, 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. Your scar is likely to be red and raised at first, but most get smaller and fade significantly over several months.
Some types of creams and gels can cause a stinging or burning sensation when you apply them. Your skin can also become inflamed – you may have itching, burning, redness and pain. This is often an expected effect of these treatments and shows that your skin is responding. The inflammation will settle down once you have stopped the treatment.
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?
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.
Although the majority of skin lesions are benign (non-cancerous), it’s important to remember that some skin lesions can turn out to be cancer. Skin cancer is often painless and there are several types that can look different. Basal cell carcinomas (also known as rodent ulcers) may first appear as a scab that bleeds and doesn't heal, as a flat red mark, or as a shiny lump. Squamous cell carcinomas often appear as a small pink lump with hard or scaly or crusty skin. Malignant melanoma is the most serious type of skin cancer. It usually starts as a new dark spot or mole on your skin, or a change in an existing mole. This can be a mole that gets bigger, changes shape or changes colour.
If you notice any new mole, spot, lump or patch on your skin that doesn't heal after a number of weeks, see your GP. Although chances are it won't be skin cancer, it's important to get it checked.
Find out more about what changes to look out for with moles.
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?
Skin tags, including those from near your eyes, can be surgically removed, destroyed with heat therapy or frozen off with liquid nitrogen. Your doctor can tell you what would be best in your situation.
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). They also often form on eyelids.
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
- heat therapy (cautery)
Your doctor will be able to explain your options and help you to decide which method is best for you.
Keloid scars, also known as keloids, are abnormal scars that have grown larger than the original wound. They become raised, lumpy and often red.
Most people's skin scars normally disappear. It's not fully understood why some people develop keloid scars. But they seem to form when your body produces too much of a substance called collagen (a protein found in skin). Keloid scars are more common in people with dark skin, and are more likely to develop between the ages of 10 and 30. You may be at risk of getting a keloid scar if you’ve had one before or if members of your family have them.
Sometimes keloid scars can feel painful, itchy or prickly, or cause a burning sensation. Unlike normal scars, keloids can develop after relatively minor skin damage, such as an insect bite, piercing, vaccination or acne spot. They can form on any part of your body, but are most common around your shoulders, upper chest and neck, as well as your earlobes.
Keloids can be very difficult to treat. It's rare to have them removed with surgery, as they're likely to grow back if you have them cut out. Other treatment options include the following.
- Steroid injections into the scar. You'll usually need to have the injections once a month for around four to six months. You can also have steroids in the form of a cream or tape that you apply to the scar. This can be more appropriate for children.
- Silicone sheets, gels or sprays. You can buy these from a pharmacist without a prescription. You need to use them for several months to have an effect.
- Liquid nitrogen (cryotherapy) to freeze keloid scars, which can help to stop their growth. This can be used on its own or with other treatments.
- Laser treatment to lessen the redness, although this won't shrink the scar.
With keloids, prevention really is better than cure. If you know 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.
- British Association of Dermatologists
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- British Association of Dermatologists
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