Excision of Benign Lesions (moles, cysts)
Benign skin abnormalities are incredibly common; we all have them, scattered over our bodies. Most skin irregularities develop with time and are a consequence of skin aging hence, adults have skin lesions more frequently then kids. The commonest skin lumps and bumps seen in the clinics are moles, skin tags, warts, cysts and keratoses.
Moles are harmless skin growths that can appear at any time in your life. Some moles are “beauty spots”, but others may look unattractive and be a source of concern. Children and teenagers tend to develop flat brown moles. After the age of 20, we tend to acquire domed, clear or pink moles which can enlarge with age and/or become hairy with time. Moles are harmless, but can be unsightly, cosmetically unacceptable and be a nuisance, especially if repetitively caught on clothing, necklaces and combs, or cut during shaving. Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. These cells are called melanocytes, and they make the pigment that gives skin its natural colour. Moles may darken after exposure to the sun, during the teenage years, and during pregnancy.
Cysts are blocked skin ducts. As the ducts get blocked, skin sebum/sweat and daily skin debris collect under the superficial layers of the skin and produce firm swellings. They always enlarge slowly, but rate of growth is impossible to predict as it depends on individual rate of skin metabolism. They can become infected and require treatment with antibiotics, sometimes even a surgical input.
Keratoses are harmless thickenings of the superficial most layer of skin (epidermis). They present as flaky, scaly flat changes which can be itchy, but very rarely painful. Many people find them annoying as they get repetitively caught with underwear, clothing, jewellery etc.
Once treated, your mole or cyst is unlikely to grow back. Generally moles and cysts enlarge with time whereas scarring produced by removing the lesions improves with time. Larger lesions require more extensive surgery to remove them, but general anaesthetic is very rarely required.
What is involved in removal of a skin lesion?
The most important step is to confirm benign nature of concerning lesion. In most cases, this is feasible by clinical examination only. If however, classical diagnostic features are not apparent, then tissue biopsy may be required first to exclude skin tumors which usually require more radical treatment. The results of tissue sample analysis are normally available within 10 days of your surgery, in urgent cases in can be just a few days.
Operation is performed under local anesthetic and usually takes between 20-30 minutes. It is carried out in the outpatients minor operating room so no formal hospital admission is required.
In my practice, lesions are most commonly removed by means of curretage (shaving) or excision (cutting of the lesion and the small area of nearby skin). As always, each one has its pros and cons. Curettage wound does not require suturing and will heal on its own in approximately 2 weeks with regular change of dressings. It can however, leave a small patch of paler skin in the long term. Removal by excision, on the other hand requires suturing. This is always done with the finest possible stitches in order to irritate tissue least and induce minimal scarring. I personally like to use one long stitch, hidden under the skin surface which is easily pulled out in 1-2 weeks. This method is technically trickier, but in expert hands, it is a very straightforward undertaking.
Complications are minimal and fine suturing predictably leads to a hardly noticeable scar, without any suture marks (picture). If the wound is truly very small, closable by only two tiny sutures, I may decide to stitch it with 2 individual sutures as shown on picture 2.
Wound is protected with a surgical tape and elegant, ‘shower proof’ dressing for 1-2 weeks. Such dressings will most likely to stay in place until you are reviewed by the nurse in 7 days. We usually provide patients with spare dressings for exchange at home in case original ones become too messy. I usually review the wound and remove sutures if necessary at 2 weeks.
You will be provided with a separate leaflet on early wound care once procedure is completed.
Potential risks and complications
Patients must understand that removal of all lesions is done at an expense of a small scar. The aim is however, to produce a scar of a very good quality, which will eventually, be ever so faint i.e. less noticeable and conspicuous then original lesion. This is achieved in over 97% of my patients. Unfortunately, there is a small risk (2-4%) of postoperative infections, delayed healing or hypertrophic healing which might produce less then optimal scars. Although, this is very rare, patients should be aware of such risks, especially when considering removal of a lesion which is essentially benign.
Complications to consider are:
- wound infection
- wound breakdown (dehiscence)
- numb patch
- hypertrophic/keloid scarring
- scar itchiness