Consultant Plastic, Reconstructive and Aesthetic Surgeon

Treatment of Benign Skin Conditions

The following are some of the more common methods of treatment of Benign Skin Conditions.

Cryotherapy (=freezing = liquid nitrogen)

This is similar to treatment for warts. In my practice, I do not particularly recommend it on the face, as I consider there are more accurate ways of treating the lesion. However, it is frequently used for large or multiple lesions on the chest or back.

Shave Excision

For lesions which are very superficial on the skin, such as seborrhoeic keratoses, it is usually possible to shave them off the surface. This leaves a small graze, roughly the diameter of the existing lesion. This heals like any graze, taking one to two weeks. It is best to consider this like an abrasion, or how it felt scraping your knee as a child. A scab forms. The scab gradually falls off and the new skin underneath heals. The first skin that comes through is relatively pink in nature and gradually settles back to normal skin colour. As only the skin surface is affected by this treatment, it is unlikely to leave any significant scar, but can sometimes result in slightly altered pigmentation of the skin. As the deep layer of the skin is not removed, lesions treated in this way can recur, and it is not recommended as a definitive treatment for skin cancer.

Excision

Excision of the lesion under local anaesthetic can be undertaken. This includes the outer and the deeper layers of the skin. This means the “root” of the lesion is also removed and therefore the potential for this particular lesion to recur is extremely low. If the deeper layer of skin is removed, the wound needs to be stitched and as the deeper layer of skin is involved, it will leave a scar.

Which procedure is “best”?

Patients can make a decision between having a more superficial shave procedure which minimises the potential for the scar, but which does have the possibility of future recurrence as the deeper layer of the skin is not removed. The alternative is to remove these deeper layers, but this will definitely mean a scar, even if it fades. If lesions are multiple, it is generally recommended to use surgical excision for the more troublesome or inflamed lesions or the lesions where there is some doubt as to their true nature, and to treat the more minor or superficial lesions with cryotherapy or shave excision.