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Subject: Skin Tag Removal
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Required instruments depend on method selected for removal. If scissors removal is chosen, a pair of new, sharp, curved iris scissors should be available. If cryosurgery or electrosurgical excision is performed, see Cryosurgery of the Skin and Radiosurgical Skin Surgery (LEEP) for descriptions of the needed equipment. Skin preparation recommendations appear in Appendix E.
Removal of superficial, polypoid growths on characteristic surfaces of the neck, groin, and eyelids
Pigmented skin lesions (especially flat lesions) generally should not be destroyed because of the possibility of the lesion being a melanoma. If there is any concern about an unusual appearance of a lesion or confusion about whether a lesion is a skin tag, the lesion should have a full-thickness biopsy and histologic assessment.
Fibroepitheliomas (often called large skin tags) often have a larger arterial supply that will require bleeding control and possibly suture closure.
PITFALL: It is easier to remove tags that are elevated with forceps. However, forceps pull up normal tissue beneath the tag, producing more scarring because of the deeper dermal injury. Dark-skinned individuals develop much more hypopigmentation and even keloid formation at skin tag removal sites when forceps are used. Avoid the use of forceps and learn to elevate the lesions in the blades of the scissors.
PITFALL: Straight iris scissors are often preferred by experienced clinicians, but may inadvertently pull surrounding tissue into the blades of the scissors. Curved iris scissors are easier to use for novice practitioners and may minimize the risk of removing excessive tissue.
PEARL: Talk to the patient during the procedure because “verbal anesthesia” usually helps. For instance, tell the patient to take a deep breath as the skin tag is cut.
PEARL: Silver nitrate provides good hemostasis in this setting but runs the risk of depositing black silver salts under the skin (tattooing), which may later be confused as a developing melanoma.
PITFALL: Avoid full-thickness or deep cuts or burns, because greater scarring is produced.
PEARL: Benign lesions will fall off within 1 week and usually heal without problems.
PITFALL: This method is slow and primarily used when only a few lesions are present.
Picture courtesy of Dr. Russell Roberts.