Removal of Lesions and Beauty Marks – Dr. Acky Friedman

What are skin lesions?
Skin lesions are lesions that appear on the skin, and may be there from birth or acquired during one’s lifetime. The cause of these lesions raises the question of whether they have medical significance and if there is a need or will to remove them. Among known lesions: moles (beauty marks), whether they are flat or not, hemangiomas (blood vessels that appear on the skin), viral warts in various body parts (flat warts in facial area and hands, bold warts in hand and feet), loose skin around the eyes, neck, armpit, groins, age spots (brown, flat spots around the head, neck, arms and thighs) and many other skin lesions that appear on various body parts as a result of age, infection (viral warts), hormones (facial pigmentation due to birth control pills/ pregnancy and breastfeeding), skin lesions that appear due to depression of the immune system (due to diseases/ medical treatments) and more.

To remove or not to remove? This is the question!
The answer to this question is that almost any lesion may be removed, however, this is not the only hesitation that should be considered when we approve the question of whether or not to remove lesions, especially those that we identify as benign and want to remove for aesthetic reasons only.

Before anything else, we must clarify one main issue: the test and diagnosis should be done by a specialized skin care doctor.

According to recent medical literature, there should be constant collaborated control: the patient should check the relevant lesions once a month for changes (size, display, color, borders, etc.) and have checkups at a dermatologist twice or three times a year. The frequency of checkups depends on the number of warts, type and tone of skin, and relevant medical history (if there were found/removed/treated skin lesions in the past, or if there is a family history of problematic skin lesions). If there is a suspected lesion (whether new or old, a known lesion that changed) go to a specialized doctor for a checkup, where sometimes an excision (biopsy) of the wart will be performed. In this situation, we care more about the medical necessity, while trying to preserve, as much as possible, the aesthetic side of the procedure, whether it’s a diagnosis excision (benign results) or whether for continuous treatment (a non-benign result). In cases where there is a suspicion of malignancy, there should be a surgical procedure and the lesion should be sent to the lab (pathology). In this case, the lesion should not be destroyed (by fluid nitrogen, burning, laser) since there won’t remain any testable tissue. Where the lesions are found to be benign or identified as such from the beginning at high probability (by the doctor), the question of aesthetic result may come up again after the end of the procedure.

In this context, it is important to notice a number of factors regarding the quality of result:
1. The ability of the skin to heal – a genetic and unchangeable trait.
2. The location of the skin lesion – a skin lesion in an area where there is a lot of tension may heal less successfully than a skin lesion in an area with no tension at all.
3. The size of the lesion and its depth in the skin tissue – large/ deep lesions may create a scar (keloid) and the treatment and elimination of this scar can be long and frustrating.
4. Type of treatment – there are a variety of therapeutic options for removing lesions, such as surgical removal/fluid nitrogen/electric burning/laser and more. The choice of removal should consider future results and the side effects that may occur after the procedure. For example, the appearance of scars or spots in lighter/darker shades from skin tone (hypo/hyper pigment) as a result of heat energy (laser), or cold energy (Nitrogen) on the treated area. These spots are problematic to treat and remove. An important factor to consider is sun exposure. Limited exposure is recommended in all cases today. When having aesthetic procedures, and especially in areas that are hard to hide from sun exposure (face, neck) we must consider all of the above and have the procedure in the winter. Note that in Israel, the sun shines strongly in the winter,  as well, so it is best to avoid exposure of the treated area at this time, too.
In conclusion, if it is a voluntary procedure, then we may take into consideration all factors, especially if the procedure is supposed to be in revealed areas such as the face and neck. Preventing complications is a much better way of dealing with them than attempting to take care of them if and when they show.

Summary:
1. Self-test your lesions once a month.
2. Check up at dermatologist twice to three times a year.
3. Every lesion that displays a change requires a checkup at a dermatologist.
4. Removal of lesions may only be performed by a dermatologist or plastic surgeon.
5. Consider the possible aesthetic results of the procedure, taking into consideration the location, size, genetics, method of treatment and sun exposure of the treated area.
6. Tests sent to the lab – the patient must checks lab results a month afterwards.
7. Do not wait and count on the doctor to say if there is a need to continue treatment – double check it yourself!

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