Chapter 3: Treatment of Lumps and Bumps

REMOVAL OF SKIN TAGS

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.

Liquid nitrogen therapy

1. Use a pair of forceps (dissecting or artery) to grasp the skin tag, preferably on the base or stalk.

2. Holding the skin tag upright and taut, apply a liquid-nitrogen-soaked cotton bud to the forceps close to the tumour (Fig. 3.1).

3. Apply for several seconds to freeze the tumour. It can be left or cut off with scissors.

A variation

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.

Bone forceps method

A simple procedure is to crush the base of the skin tag flush with the skin using bone forceps (Fig. 3.2a). The advantages are that:

• no local anaesthetic is required

• the procedure is relatively painless

• the procedure is very quick

• immediate haemostasis is achieved (Fig. 3.2b).

REMOVAL OF EPIDERMOID (SEBACEOUS) CYSTS

There are several methods for removal of epidermoid cysts after infiltration of local anaesthetic over and around the cyst. They are the most common cutaneous cysts, which have a cheesy keratin material (not sebum). They can occur anywhere but most commonly on the face, scalp and trunk. These include the following methods.¹

Incision into cyst

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.

Punch biopsy method

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 ...