Skin Lesions

What are the most common benign lesions?

Benign is a fancy term for something that is NOT cancer (malignant).

MOLES

These are those growths on the skin that can be flesh colored, brown or even black. While most of them are first seen in childhood, some moles can show up later in life. These may start off flatter and over time become raised or even undergo some color change, usually becoming lighter. Some can have a hair coming out of them as well. Many moles are benign, and nothing to be concerned about.

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When should I be concerned about a mole?

If the mole changes shape, color, height, size, or if they start to bleed, ooze, itch, become tender or even painful. The usual tip that is used to help you know when you should get your moles checked out is the ABCDE guide.

A – stands for Asymmetry. This means that the two sides of the mole don’t match.
B – stands for Border. This means that you should have the moles checked if the border or the edges are not sharp, rather it is blurry, irregular or if it looks “fuzzy”.
C – stands for Color. If there are multiple colors in the moles like different shades of brown, tan, black, white, red or even blue, you should have the mole checked.
D – stands for Diameter. This means if you measure the mole from side to side [the diameter] it should be smaller than the top of a pencil eraser.
E – stands for elevation or Evolution. This means that if the moles are becoming raised from the skin, or if they are changing over a short time, then you should have the mole checked.

What causes moles?

The cause of moles isn’t really known. It is thought that it is a combination of genetics, environmental exposure and possibly even hormones.

Can you prevent moles?

Not really, however protecting your skin from environmental exposure theoretically may prevent some moles from developing.

Treatment for moles?

If they are benign, moles do not need to be treated. If they appear on an area that is cosmetically unappealing, then they can be removed either surgically or with a laser.

SKIN TAGS

What is a skin tag?

Skin tags are growths that tend to develop in areas that have creases, namely the neck, under the arms, under the breasts, or groin area. They can also be found anywhere on the chest and back.

It is not clear why they develop but can occur with weight gain, or simply with aging. They are usually the same color as the rest of the skin, but the excess tissue is connected to the skin by some form of stalk.

On occasion skin tags can hurt when they get twisted, thereby cutting off the blood supply, or when clothing or jewelry rubs on them.

Can you prevent skin tags?

Not really, other than maintaining a stable weight and making sure your hormones are balanced.

TREATMENT FOR SKIN TAGS

While they do not need to be removed, many people find their skin tags cosmetically unappealing. There are many methods for removing skin tags from cauterization (heat or burning off), cryotherapy (freezing off), or cutting off.

FRECKLES AND SOLAR LENTIGINES

What are freckles and solar lentigines?

Both of these are flat brown spots that develop on the skin.

Freckles are typically found in younger children and are genetic. The genetic variation that causes the skin to form these brown flat “freckles” is usually also responsible for fair skin, red hair and/or a tendency to burn easily.

Lentigines, on the other hand, are brown spots that can occur on all individuals and are usually found on sun exposed surfaces like the face, neck, check, back of hands, especially in areas that have been sunburned at some point in time. They too are much more common in individuals who have fair skin.

Can I prevent freckles or solar lentigines?

Freckles – no, they are genetic, but staying out of the sun and wearing UV protection will keep them faded.

Solar Lentigines are directly linked to UV exposure, so protecting the skin from UV exposure is key to preventing their formation.

TREATMENT FOR FRECKLES AND SOLAR LENTIGINES

Freckles simply fade when the skin is no longer exposed to UV light. There is no real treatment for genetically produced freckles.

Solar lentigines can be treated with multiple modalities including:
1. Skin care products
2. Cryotherapy
3. Laser surgery or
4. Light therapy – like broad band light or intense pulsed light

SEBORRHEIC KERATOSES (SK’S)

What are seborrheic keratoses?

Seborrheic keratosis are those brown or black growths that usually have people concerned about skin cancer. They tend to be raised, and they come from the cells in the skin that form keratin. They often look like warts and can be very distressing when they develop on the face. They are usually found on the chest, back and head.

What causes seborrheic keratoses?

It is unclear why seborrheic keratoses develop in some people but not others. Exposure to UV radiation may be involved given the distribution, but it is not really well understood.

Can you prevent SK’s?

Given that we really don’t know what causes SK, we cannot give any guidance on what one should do to help prevent them.

TREATMENT FOR SEBORRHEIC KERATOSES

There are lots of options for treatment including:
1. Surgical removal
2. Cryotherapy
3. Cauterization
4. ESKATA

ESKATA – New treatment option

ESKATA is hydrogen peroxide that is encased in a special pen that the doctor activates at the time of treatment. The exact mechanism of action is not really known, but it is very effective.

How is the ESKATA Treatment performed?

The SK is cleaned with an appropriate surgical cleanser and then wiped with alcohol.  The pen is then activated and primed and the hydrogen peroxide is rubbed into the SK for 10-15 seconds. The area is allowed to dry and the application is repeated 2-4 times depending on the response. The SK may then become irritated and red looking for a couple of weeks, after which it becomes much less noticeable and can fully disappear.  Some SK’s may require a second treatment at 3 weeks. It is an extremely safe and effective treatment for raised SK’s