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Procedures

Cosmetic Procedures  Skin Lesion Removal

Skin Lesion Removal Techniques

A broad array of techniques is available to remove skin lesions.  The more superficial the lesion the simpler the treatment and recovery; the deeper the lesion, the more aggressive the treatment needed and the longer the recovery. All facial skin lesions, other than large cancerous lesions, require relatively simple treatment and have rapid recovery with inconspicuous healed sites.


Treatments in order of increasing aggressiveness:

Topical Products:  include retinoids such as tretinoin, and Retin-A, bleaching agents such as hydroquinone and azalic acid, and antimetabolites such as Efudex (fluorouacil). These products work to alter the chemistry of the abnormal tissue to reverse the lesion process.

Electrocautery, Radiofrequency, and Liquid Nitrogen:  have similar effects in removing superficial lesions such as skin tags, cherry angiomas, and actinic keratoses. These modalities break down the lesions so that they can be wiped off of the normal, underlying tissue. The surface heals rapidly in a similar manner to an abrasion.

Surgical Excision:  is used for all deeper lesions to ensure that the entire lesion is removed.  An incision is made around the lesion, the dissection is extended under the lesion to completely remove it, the wound edges are loosened and then sutured together.  The face generally heals better than any other area of the body, so most scars are very thin and blend into the surrounding skin beautifully.

 


Harmless Facial Growths:

Age Spots -- These flat, brown lesions become noticeable as we age.  A topical retinoid, like Retin A, often in conjunction with bleaching cream and a mild topical steroid -- may gradually fade an age spot.

Skin Tags -- These flesh-colored growths protrude from the skin, often on a stalk. They can multiply rapidly, but they can be removed easily and painlessly with surgical scissors, an electrical device or liquid nitrogen.

Cherry Angiomas -- These small, smooth, cherry red spots range from pinhead size to ¼ inch across. They can be removed with a laser, liquid nitrogen or an electrical device.

Spider Nevi -- have a dark red center with red streaks radiating outward in all directions. They are painlessly removed by cauterizing the central blood vessel.

Seborrheic Keratoses -- These brown, slightly elevated, black or pale growths look waxy, as if they were dripped on the skin by a candle. Their size ranges from ¼ inch to 1 inch across. They can be removed easily by scraping or with liquid nitrogen.


The cost of removing any of these harmless spots -- considered cosmetic procedures -- is not covered by insurance.


Cancerous Facial Lesions Include:

Actinic Keratosis

This is a precancerous lesion. It is a scaly, crusty, rough lesion caused by sun exposure. They may be light or dark, tan, pink, red, a combination of these, or the same color as ones skin. They are also called solar keratosis, sun spots, or precancerous spots. They are also called "AK's" for short. They range in size from as small as a pinhead to more than an inch across.

Actinic keratosis can be the first step in the development of skin cancer, and, therefore, it is a precursor of cancer. About 10 to 15 percent of active lesions, which are redder and more tender than the rest, will progress to squamous cell carcinomas.

 

Basal Cell Carcinoma

Sometimes called non-melanoma skin cancer.  It usually appears as a small, fleshy bump or nodule.  In the USA, 90% of skin cancers are this type.  Basal cell carcinoma is easy to diagnose and is mostly easy to treat successfully.  If left untreated it can spread to other parts of the body and can extend below the skin to the bone, causing significant local damage.  People with basal cell carcinoma are at higher risk of developing other skin cancers.

Basal Cell Carcinoma is most commonly found among Caucasians. It very rarely occurs among dark-skinned individuals.  People with light hair, light colored eyes, and fair complexions are much more likely to get it, compared to those with darker colored eyes, hair and complexions.

Squamous Cell Carcinoma

It often appears as nodules on the skin. It is usually found on the rim of the ear, face, mouth and lips, but can also spread elsewhere in the body.  It can also appear as red, scaly patches.  It is generally found in the skin of Caucasian people, especially those with very fair skin.  It is more aggressive than Basal Cell Carcinoma, but is still easy to treat successfully.

Malignant Melanoma

The cancer cells are the pigment cells of the skin, the melanocytes.  Although it is extremely rare in teenagers and children, there have been cases. It is predominately found in adults.  This is the most aggressive form of skin cancer.  Fortunately, it is also the rarest.  75% of all skin cancer deaths are from malignant melanoma.  It is most commonly found among fair-skinned people. However, people of all skin types can get it.

 

How is Malignant Melanoma Identified?

The First Signs of a Melanoma Could Be:

 

  • A new mole appears.
  • An existing mole changes in appearance from its usual single color and round/oval shape, not larger than ¼ of an inch (6mm) in diameter.
  • Melanomas look like moles with an irregular shape. They tend to have more than just one color. They are generally larger than ¼ of an inch (6mm) in diameter.
  • With some patients the melanoma may itch, and even bleed.

 

ABCDE Checklist for Identifying A Melanoma:

 

  • Asymmetrical - the mole is not symmetrical, one half is different in shape from the other.
  • Border - the border is ragged or notched. Most normal moles have regular borders.
  • Colors - while most normal moles have just one color, melanomas often have two or more.
  • Diameter - the diameter of a melanoma is greater than most moles (1/4 inch or 6mm)
  • Elevation - when touched the melanoma will feel slightly raised above the skin.  Enlargement - is another identifying characteristic of melanoma.


Doctors depend on overall pattern recognition and comparison, rather than specific analytic criteria, to distinguish melanoma lesions (malignant skin cancer) from harmless skin moles.

 

Who is at High Risk of Developing Malignant Melanoma?

 

  • Those with a history of blistering sunburns as a teenager.
  • Those who had outdoor summer jobs for three or more years as a teenager.
  • People with pale skin, especially skin that does not tan easily (goes red instead). People with red hair. 
  • People with blond hair.
  • People with light eyes (blue).
  • People with many moles.
  • People with many freckles.
  • People with HIV or any condition that lowers their immune system.
  • People taking immunosuppressants (medicines to depress your immune system).
  • People with a family history of melanoma.

 

If you have a lesion that changes size, shape or color, you should see a surgeon without delay.