Pt Information

Symptomatic Lesion Removal

Raised Symptomatic Lesions

What are these symptomatic lesions?

Various types of lesions can be raised and cause symptoms. Most commonly are moles, seborrheoic keratoses, skin tags and cherry haemangiomas.
They may create symptoms such as itch, soreness, irritation or a just a vague discomfort.
Some get irritated by shaving, physical activities, or simply by wearing of hats, glasses or masks.

Are raised symptomatic lesions dangerous?

The majority of raised lesions, especially the long standing ones that have not changed, are not cancerous.
However, there are always exceptions, and some of the most dangerous skin cancers are known to have the "EFG" features, being Elevated, Firm and Growing.

Can all raised symptomatic skin lesions be removed?

All raised skin lesions CAN be removed one way or another. After all, our daily job is to detect and remove skin cancers, whether they are flat or raised.
It is a different consideration whether some are worthwhile removing.

Can raised symptomatic skin lesions be removed without a scar?

All lesion removals will result in a scar. A scar is our body's reaction to skin trauma and its attempt to repair the trauma.
The way our skin reacts to trauma is mostly genetically determined.
It will also change with age, with younger age being associated with more active scarring.
Some locations will also react more highly to trauma, for example the chest and upper shoulders.

Should I consider having my raised symptomatic lesion removed?

We suggest you consider the symptoms that the lesion is causing you, or is likely to continue to cause you, against the possible range of post treatment results as discussed here.

Why is there a different technique of removing a raised lesion?

The technique of flat shaving of a raised lesion aims to reduce the symptoms but at the same time minimise the deeper trauma of traditional cutting and stitching.
In other words, our primary aim is to reduce the symptom of the lesion being raised, rather than cutting deep to remove everything. Cutting deeper naturally causes more scarring.

Can a "removed" raised lesion come back?

Moles and lesions consist of living cells, with an inbuilt ability to regenerate.
When we remove a lesion, the body immediately starts a healing and repair process.
In some people the repair process can lead to a slight regrowth of the lesion. This is what nature has programmed the cells to do. It is not abnormal and is to be expected to some extent.
Some lesions have pigment deeper down in the skin and some residual pigment may remain after removal. This is especially common where there are thicker hairs associated with the lesion. The pigment is stored in the hair follicles lying deeper in the skin.
In our estimate, about 2/3 of lesions do not re-grow at all and the area remains flat. In the remaining 1/3, there is some re-growth but most patients view it as minor, and not requiring further treatment. Less than 5% (<1 in 20) may opt for a second treatment.

What Happens During The Procedure

How We "Remove" / "Flatten" These Lesions

The lesion must be checked for clinical suspicion by one of our doctors. This may be a Spot Check or a Full Body Skin Check consultation
It must be deemed suitable for a shave removal after the clinical examination. This includes examination for “depth” of the lesion.
The lesion is then marked and its level of protrusion gauged.
The skin is then prepped
A small amount of local anaesthetic is injected. This should feel similar to a flu injection.
The protruding skin lesion is then shaved as close to the surrounding skin as possible.
The base will be cauterised lightly to help seal the blood vessels.
Sutures are not used.
The area is then dressed with an ointment and a dressing is applied.
In most cases, a sample of the tissue will be sent to a pathology laboratory for definitive testing.

Some Examples

An example of a raised lesion which was creating symptoms

This achieved the purpose of flattening the lesion

An example of a raised lesion which was creating symptoms

This achieved the purpose of flattening the lesion

An example of a raised lesion which was creating symptoms

This achieved the purpose of flattening the lesion

An example of a raised lesion which was creating symptoms

This achieved the purpose of flattening the lesion

An example of a raised lesion on the upper shoulder

This achieved the purpose of flattening the lesion

This raised lesion on the scalp was a cause of frequent pain and trauma

This achieved the purpose of flattening the lesion

This large raised lesion has internal pigmentation

We were able to flatten the lesion but some pigmentation remains deep in the skin. A small excision can be used to remove this pigment although we advise makeup is just as effective

This raised lesion repeated bled due to shaving cuts

This achieved the purpose of flattening the lesion

This raised lesion repeated bled due to shaving cuts

This achieved the purpose of flattening the lesion

During the Treatment

Raised Lesion

Immediately after removal and before cautery is applied

This raised lesion was a source of irritation for this patient

Immediately after the lesion was removed but before cautery

This raised lesion was a source of irritation for this patient

Immediately after the lesion was removed and cauterised

Post Treatment Advice

Wound Care

Leave the original dressing on for the first 48 hours and do not wet it. After 48 hours, aim to change the dressing daily.
Keep the wound “greasy” with an ointment such as pawpaw or plain vaseline.
Bio-oil and Vitamin E oil is generally too light and not able to keep the wound edges from drying out.
Keep the wound away from dust or dirt. Cover it with a simple bandaid if outside or exposed to dust.
Keep applying the ointment daily until there is no longer a scab
Minimise excessive movement of the area for the first 2 months.

How to maintain the optimal result

New skin cells grow to cover the wound. They are VERY sensitive to direct and indirect sunlight (including shade).
The cells may develop darker pigment from just an average degree of sun exposure.
Use sunscreen with high UVA protection daily for at least 3 months unless covered by clothing.

What if the lesion is still very raised

If the lesion is still very raised after 6 weeks, return for a review.
We can “touch up” by shaving a little more of the lesion.
If the lesion is more raised than before, it suggests a hypertrophic scar formation. Please return so we can review the wound.

What To Do If You Are Interested To Proceed

Option 1 - Getting everything ready so if time permits at your next skin check appointment, the doctor MAY be able to perform the SLR at the same visit. This requires several events to line up:

You have chosen a doctor who performs SLRs.
The doctor is prepared before the appointment.
You are prepared including post-treatment care.
A SLR consent has already been completed.
- Consent is available here via our HotDoc portal.
There is residual time at the skin check consultation.
The lesion is deemed safe, benign and suitable for SLR.
Contact Us when making your appointment and mention you wish to proceed with SLR.

Option 2 - Discuss further at your next skin check appointment, then rebook a second appointment for SLR if you then wish to proceed

No preparation required for first visit but understanding the process will help the discussion.
Choose a doctor who is listed as performing SLRs.

Symptomatic Lesion Removal Fees

Raised Lesion (Moles, Seb Ks, haemangiomas, large skin tag)

$ 200 Facial (each)
$ 150 Non-facial (each)

Small Skin Tags (<5mm diameter)

$75 for skin tags (1-3), then $25 each additional

Doctors who perform SLR

Dr [Block//First Name] [Block//Last Name]