Skin Lesion Treatment

Skin lesion treatment covers the assessment and removal or treatment of various skin growths and changes. Many of these lesions are benign and are bothersome mainly because of how they look, irritation from rubbing or catching on clothing. Others need to be removed and analysed to establish their exact nature.

Before any treatment, the lesion is assessed by a dermatologist, including with dermatoscopy. At Detalii Med in Baia Mare, assessment and treatment are carried out by Dr Alina Perța, senior consultant dermatologist, and Dr Greta Jurj, specialist dermatologist.

Treatment is intended for people who have, for example:

• warts on the hands, soles of the feet or other areas;
• small, soft growths on the neck, in the armpits or on the eyelids, known as skin tags;
• seborrhoeic keratoses, slightly raised brown lesions that are common from a certain age;
• actinic keratoses, rough patches on skin exposed to the sun for many years;
• cysts, milia or other small growths;
• moles or growths that need to be removed for medical or cosmetic reasons.

Any new lesion, or one that grows, bleeds, ulcerates or does not heal, should be shown to a doctor as soon as possible.

Most benign lesions can be removed or treated with a good cosmetic result, usually in a short outpatient procedure. For surgically removed lesions, histopathological examination confirms the diagnosis and shows whether the lesion has been removed completely.

Any removal of a lesion can leave a mark, such as a fine scar or an area that is lighter or darker in colour. Warts and some other lesions can come back, even after correct treatment. Suspicious-looking lesions are not treated with methods that destroy them without analysis; they are removed and sent for histopathological examination.

The doctor asks how long the lesion has been present, whether it has changed, whether it hurts, itches or bleeds, and whether the patient has had similar lesions before. Other conditions, treatment with anticoagulants or antiplatelet medicines, allergies, including to anaesthetics, and any tendency to form raised scars are also important.

After the clinical and dermatoscopic examination, the doctor explains the likely diagnosis and recommends a suitable method. The patient is informed about the benefits, risks, alternatives and aftercare, and signs an informed consent form before the procedure.

The method is chosen according to the type, size and location of the lesion. Common options include:

• surgical excision with stitches, followed by histopathological examination, for moles, cysts or lesions that need to be analysed;
• shave excision or curettage, for some superficial lesions;
• cryotherapy, the application of intense cold, for warts or keratoses;
• electrocautery, for skin tags and other small lesions.

The procedure is usually done as an outpatient and takes from a few minutes to about half an hour, depending on the lesion. The area is cleaned and disinfected, and a dressing is applied at the end. When appropriate, the removed tissue is sent to the laboratory for histopathological examination.

For excisions, shave excision and electrocautery, local anaesthesia is usually used, by injecting an anaesthetic around the lesion. A needle prick and a brief stinging sensation are felt during the injection, after which the area becomes numb. Cryotherapy is generally done without anaesthesia, and the patient may feel a short-lasting sensation of intense cold or burning.

The patient can usually return to their normal activities the same day. The treated area is cared for according to the doctor's instructions: the dressing is kept clean and dry, and strenuous exercise is avoided for the first few days if the lesion was stitched.

Stitches are removed, depending on the area, usually after about 7–14 days. After cryotherapy or electrocautery, blisters or crusts may form, which normally heal within one to three weeks. The scar should be protected from the sun for a few months.

The risks are generally low, but should be known: bleeding, infection, mild pain after the procedure, delayed healing, a visible or raised scar, colour changes in the treated skin and recurrence of the lesion.

The risk of scarring depends on the size and location of the lesion, the method used and the way each person's skin heals. The patient should contact the doctor if they notice spreading redness, local warmth, discharge, fever or bleeding that does not stop.

The lesion is usually removed in a single session, but warts or keratoses may need several cryotherapy treatments, a few weeks apart. The histopathology result is usually available within a few days to a few weeks and is discussed at the follow-up visit.

The scar matures gradually and becomes less visible over a few months to a year. The final appearance depends on the treated area and on how each person heals.

Skin growths can usually be removed or treated with short outpatient procedures. The essential step is a dermatological assessment before treatment, to choose the right method and avoid overlooking a lesion that needs to be analysed. Surgically removed lesions are sent for histopathological examination where needed.