Skin tags (fibroepithelial polyps) are very benign tumours, and can safely be left. However, patients often request their removal for cosmetic reasons. There are several ways to remove skin tags. These include:
simple excision (see also Perianal skin tags for elliptical excision)
cutting with scissors
electrocautery (to base); a very effective method
tying a fine thread around the base
crushing with bone forceps
liquid nitrogen therapy.
Use a pair of forceps (dissecting or artery) to grasp the skin tag, preferably on the base or stalk.
Holding the skin tag upright and taut, apply a liquid-nitrogen-soaked cotton bud to the forceps close to the tumour (Fig. 5.1).
Apply for several seconds to freeze the tumour. It can be left or cut off with scissors.
Removal of skin tag by liquid nitrogen
The tips of the forceps can be dipped directly into the liquid nitrogen and then clamped onto the base of the skin tag. Multiple tags can be frozen rapidly in this way.
A simple procedure is to crush the base of the skin tag flush with the skin using bone forceps (Fig. 5.2a). The advantages are that:
no local anaesthetic is required
the procedure is relatively painless
the procedure is very quick
immediate haemostasis is achieved (Fig. 5.2b).
Removal of skin tag using bone forceps method
REMOVAL OF EPIDERMOID (SEBACEOUS) CYSTS
There are several methods for removal of sebaceous cysts after infiltration of local anaesthetic over and around the cyst. These include the following methods.
Make an incision into the cyst to bisect it, squeeze the contents out with a gauze swab and then avulse the lining of the cyst with a pair of artery forceps or remove with a small curette.
Use a 5 mm punch biopsy to punch a hole into the apex of the cyst. Squeeze vigorously to express the contents. Look for the cyst wall, grasp it with forceps and carefully enucleate it. A suture is not necessary.
Incision over cyst and blunt dissection
Make a careful skin incision over the cyst, taking care not to puncture its wall. Free the skin carefully from the cyst by blunt dissection. When it is free from adherent subcutaneous tissue, digital pressure will cause the cyst to ‘pop out’.