Which skin lesions can you consult us about?
You can consult us for a single lesion or for multiple skin lesions in the same area or different parts of the body. The method of removal matters, but so do the type of mark or scar expected afterwards and, when relevant, how the resulting wound will be closed.
Moles and naevi
Moles may be raised or flat, pigmented or skin-coloured, and they do not all behave in the same way. Because a lesion described by a patient as a “mole” may represent different types of skin lesion, the method is selected according to the examination findings.
Skin tags
Skin tags are common on the neck, underarms, trunk and skin folds and may occur singly or in large numbers. Their size, base and location affect which techniques can be considered.
Changing, bleeding or diagnostically uncertain lesions
If a lesion has recently enlarged, changed in appearance, repeatedly bled or remains diagnostically uncertain, we do not proceed directly to a superficial removal treatment. We first determine whether tissue needs to be preserved for diagnosis.
Previously treated or recurrent lesions
If a previously treated lesion has appeared again, an earlier pathology report is useful when available. Before repeating the same procedure, we reassess what the recurrent tissue represents.
Skin tumours already diagnosed by biopsy
For patients who already have a biopsy diagnosis of basal cell carcinoma, cutaneous squamous cell carcinoma, melanoma or another skin tumour, we consider both surgical removal and how the resulting defect will be closed.
What do we establish at the first consultation?
We examine the lesion’s surface, pigmentation, borders, depth and anatomical location. Previous procedures and any available pathology results can also change the methods that are appropriate.
A central decision is whether the lesion is being removed only for treatment or whether the tissue also needs to be preserved for diagnosis.
When there are several lesions, we do not assume that they are all the same. Even two lesions next to each other may require different approaches.
What happens when pathology is needed?
If tissue needs to be obtained for diagnosis, we select the procedure accordingly and send the specimen for histopathological examination.
When the pathology result is available, we review the findings with the patient. If the result requires further removal, reassessment of surgical margins or a different follow-up pathway, the next step is planned accordingly.
How do we approach multiple moles or skin tags?
Having many lesions does not mean that all of them should be treated in one session or with the same method.
The number of lesions, their locations, how similar they look, the techniques required and whether pathology is needed all influence whether treatment is best carried out in one session or in stages.
For example, several similar and clinically typical skin tags may be treated together, while a lesion that looks different from the others should be assessed separately.
Which methods do we use?
Depending on the lesion, we use CO₂ laser, radiofrequency or surgical removal.
CO₂ laser and radiofrequency can be used for ablation of selected superficial lesions.
Radiofrequency is not limited to ablation; in suitable lesions it can also be used to cut and physically remove tissue. This cutting mode is also referred to as RF cutting or radiosurgery. If the quality of tissue preservation or assessment of surgical margins is important, the technique is selected with that requirement in mind.
When preservation of tissue architecture, a deeper removal or assessment of surgical margins is needed, we use surgical biopsy or excision.
For malignant skin tumours, a wider surgical excision may be required, followed by an appropriate method of closure or reconstruction.
What is the advantage of having CO₂ laser, radiofrequency and surgery within the same practice?
It allows the method to be selected for the lesion rather than fitting every lesion to a single available technique.
A narrow-based skin tag, a raised benign-appearing naevus, a pigmented lesion and a lesion requiring histopathological assessment are not managed in exactly the same way. Different lesions in the same patient may require different techniques.
For some lesions, a superficial procedure is sufficient. Others need to be physically removed as tissue. In another case, the way the wound is closed after removal may become a major part of treatment.
CO₂ laser, radiofrequency and surgical excision are therefore tools for different clinical needs rather than competing versions of the same procedure.
How does the pathway change for a suspicious or malignant skin lesion?
When malignancy has been diagnosed or there is strong clinical suspicion, surgical margins, pathology findings and the risk features of the tumour help determine the treatment pathway.
For basal cell carcinoma, cutaneous squamous cell carcinoma and melanoma, the extent of surgery depends on the diagnosis, anatomical location and characteristics of the tumour.
If pathology shows inadequate surgical margins, further excision may be required. Depending on the disease, lymph-node assessment, sentinel lymph-node biopsy, multidisciplinary review or other oncological steps may also become relevant.
We do not perform Mohs surgery in the clinic. If a specific margin-controlled technique or a different oncological infrastructure is required, the appropriate pathway is determined according to that need.
How are the scar and wound closure planned?
When surgical removal is required, wound closure is planned at the same time as removal of the lesion.
The direction of the incision, tension on the wound, anatomical location and surrounding tissues influence the position and form of the final scar.
This is particularly important on visible or anatomically sensitive areas such as the face, nose, eyelids, lips and ears, where lesion removal and wound closure are parts of the same surgical decision.
Small defects can often be closed directly. When the size or location does not allow this, a local flap or skin graft may be required.
The aim is to treat the lesion appropriately while also considering scar position and shape, surrounding contour and function.
Where and how is the procedure performed?
Many small skin-lesion procedures can be performed under local anaesthesia. The appropriate setting depends on the type and number of lesions, their location and the extent of surgery required.
Larger excisions or procedures requiring reconstruction are performed in an appropriate surgical setting.
What will be clear by the end of the consultation?
The consultation should establish which pathway is appropriate:
- observation,
- biopsy or tissue sampling,
- CO₂ laser or radiofrequency treatment,
- surgical excision,
- surgery appropriate for a malignant lesion,
- reconstruction with direct closure, a skin graft or a local flap.
If there are several lesions, we also determine which can reasonably be treated together and which should be assessed separately.
What should you expect after treatment?
Healing depends on the method used.
After superficial CO₂ laser or radiofrequency procedures, redness and crusting may occur. Surgical excision may require dressings and suture follow-up.
Protecting the healing area from the sun can help reduce the risk of pigment change. Return to everyday activities depends on the treatment area, the number of lesions and the procedure performed.
If a specimen has been sent to pathology, we review the result when it becomes available and explain whether it changes follow-up, surgical margins or the need for another procedure.
The differences between CO₂ laser, radiofrequency and surgical removal — and why tissue preservation and pathology may change the choice of method — are explained in more detail in the related Knowledge Center guide.