Moles, Growths & Warts
Almost every adult has a few moles. Most moles do not require treatment. However, you should be concerned about a mole when you notice any of these signs:
- itching or burning
- rough, scaly or crusty texture
- asymmetric shape
- irregular border
- uneven and unusual color
- diameter greater than a pencil eraser
- evolving or changing mole
- mole develops after age 20
If you notice any changes in the size, shape, color, or elevation of your moles, it's important to have it checked out by a dermatology provider. Normal moles will remain the same over the years. Changes in moles can be a sign of skin cancer.
The dermatology provider cuts out the entire mole and stitches the skin closed. If the dermatology provider suspects that the mole contains cancer, the mole will be sent to a lab. It will be examined under a microscope. This is called a biopsy.
The dermatology provider uses a surgical blade to remove the mole.
Growths | Seborrheic keratosis
Seborrheic Keratosis (seb-o-REE-ik care-uh-TOE-sis) is a common skin growth that is not cancerous. Most often seborrheic keratoses start as small, rough bumps. Then slowly they thicken and get a warty surface. They range in color from white to black. Most are tan or brown.
Because seborrheic keratoses are harmless, they most often do not need treatment. A dermatology provider may remove a seborrheic keratosis when it is hard to distinguish from skin cancer or irritates a patient.
The dermatology provider applies liquid nitrogen, a very cold liquid, to the growth with a spray gun. This freezes the growth. The seborrheic keratosis tends to fall off within a few weeks. Sometimes a blister forms under the seborrheic keratosis and dries into a scab-like crust. The crust will fall off.
Electrosurgery and curettage
Electrosurgery (electrocautery) involves numbing the growth with an anesthetic and using an electric current to cauterize (burn) the growth. A scoop-shaped surgical instrument, a curette, is used to scrape off the treated growth. This is the curettage. The patient does not need stitches. There may be a small amount of bleeding. Sometimes the patient needs only electrosurgery or just curettage.
Growths | Skin Tags
Skin tags are common benign skin growths. The medical name for skin tag is acrochordon. Skin tags typically occur in characteristic locations, including the base of the neck, underarms, eyelids, groin folds, and under the breasts.
The dermatology provider applies liquid nitrogen, a very cold liquid, to the growth with a spray gun. This freezes the growth.
Electrosurgery (electrocautery) involves numbing the growth with an anesthetic and using an electric current to cauterize (burn) the growth.
The cells of the skin tag are destroyed with a laser.
Cutting a skin tag off may begin with a local anesthesia. Once the area is numb, the doctor slices the skin tag away with a scalpel or a pair of sharp surgical shears and stops the blood flow to the tag.
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Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin, called human papillomavirus (HPV). Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat and smooth. The appearance of warts varies, depending on where they’re growing.
Warts are passed from person to person, sometimes indirectly. The time from the first contact to the time the warts have grown large enough to be seen is often several months. The risk of catching hand, foot, or flat warts from another person is small.
Some people get warts depending on how often they are exposed to the virus. Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of warts in children who bite their nails or pick at hangnails.
There are several different kinds of warts including:
Common warts usually grow on the fingers, around the nails and on the backs of the hands. They are more common where skin has been broken, for example where fingernails are bitten or hangnails picked. These are often called "seed" warts because the blood vessels to the wart produce black dots that look like seeds.
Foot warts are usually on the soles (plantar area) of the feet and are called plantar warts. When plantar warts grow in clusters they are known as mosaic warts. Most plantar warts do not stick up above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin. Like common warts, these warts may have black dots. Plantar warts have a bad reputation because they can be painful, feeling like a stone in the shoe.
Flat warts are smaller and smoother than other warts. They tend to grow in large numbers - 20 to 100 at any one time. They can occur anywhere, but in children they are most common on the face. In adults they are often found in the beard area in men and on the legs in women. Irritation from shaving probably accounts for this.
Genital warts may be small, flat, flesh-colored bumps or tiny, cauliflower-like bumps. In men, genital warts can grow on the penis, near the anus, or between the penis and the scrotum. In women, genital warts may grow on the vulva and perineal area, in the vagina and on the cervix. Genital warts vary in size and may even be so small that you can't see them. They can lead to cancer of the cervix in women or cancer of the penis in men.
Cryotherapy (freezing) is generally preferred. The dermatology provider applies liquid nitrogen, a very cold liquid, to the wart with a spray gun. This freezes the wart. However, repeat treatments at one to three week intervals are often necessary.
Electrosurgery (burning) is another good alternative treatment. Electrosurgery involves numbing the wart with an anesthetic then using an electric current to cauterize (burn) the wart.
Excision of warts in the office is effective when the bulk of the wart lies below the skin surface (particularly in plantar warts). Deeper or multiple plantar warts may need to be excised by curettage, which involves anesthetizing the involved area, identifying and marking appropriate margins, and scooping out the warts with a specialized instrument (dermal curette) possibly in combination with acid application.
For all warts in general, topical application of salicylic acid, squaric acid, canthacur ("beetle juice"), imiquimod, veregen, salicylic acid, glycolic acid, tretinoin, and other surface peeling preparations are effective.
The dermatology provider injects the wart with an intralesional candida antigen or bleomycin sulfate.
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