Moles & Cysts

Common types of skin growths which may need excision are moles, keratoses and epidermal cysts.

Moles

Moles are clusters of heavily pigmented skin cells, either flat or raised above the skin surface. While most pose no danger, some-particularly large moles present at birth, or those with mottled colours and poorly defined borders-may develop into malignant melanoma. Some moles are also known as dysplastic naevus, which are moles with atypical cells. These cells have the potential to transform into malignant melanomas.

Changes in a mole should be viewed seriously, this include change in shape, colour and size. Other warning signs include moles which were flat then became raised, moles that has suddenly started to itch, moles which ulcerate and bleed, and finally, new moles that has only recently appeared. Moles can be removed due to concerns that they may harbour underlying malignant change.

Moles can also be removed for cosmetic reasons, or they can also be removed because they're constantly irritated by clothing or jewellery (which can sometimes cause pre-cancerous changes).

Removing a mole means exchanging the mole for a scar. Superficial scraping and shaving of a mole often will result in inadequate removal and recurrence of the mole later. More importantly, it often changes the appearance of the mole, which could either make it look like a mole undergoing malignant change or make the mole itself difficult to monitor for malignant change. The best way to remove a mole completely is to cut it out and close the area with fine sutures. It leaves a small straight line scar which becomes very faint after 6- 8 weeks, and hardly visible in the long term.

All moles excised from our practice are sent off for histopathological examination to make sure that no untoward changes are occurring in these lesions.

Seborrheic Keratoses

Seborrheic Keratoses are brown raised lesions which can be small or large. These often don’t undergo any change over many years. Sometimes they can become irritated from constant picking or rubbing, and may bleed when traumatised. These are not malignant, and can be removed for:

  1. Cosmetic Reasons
  2. Constant Irritation
  3. Colour change which may be due to malignant change

Solar or Actinic Keratosis

Solar or actinic keratoses are rough, red or brown, scaly patches on the skin. They are usually found on areas exposed to the sun. It is commonly regarded as areas of sun damage, and usually is a marker of the effects of sun on your skin. A very small proportion can become skin cancers, which is characterised by thickening of the area.

These lesions can spontaneously resolve, especially with good skin care and avoidance of sun exposure. Persistent lesions can be treated with cryotherapy or salicylic acid creams, both of which can be prescribed and performed by your family doctor. They do not require excision, unless malignant change is suspected or proven on biopsy.

Epidermal Cysts

These are ingrown cysts of the skin, where skin cells cluster beneath the skin and produce oils. They can enlarge very slowly. Some do not cause any symptoms or problems, others can become troublesome. Characteristically, they undergo enlargement, and then discharge of offensive thick white/yellow paste periodically, which results in the ‘disappearance’ or deflation of the cyst. The cyst then recurs and enlarges until the next time it discharges.

Other times, the cyst can become infected repeatedly and continually discharge offensive material associated with redness, swelling, and pain in the area. Multiple courses of oral antibiotics are often required to alleviate an infective episode.

Some cysts spontaneously resolve without surgery, others may require surgical removal. Cutting out a cyst requires the removal of the cyst and its capsule; otherwise the recurrence rate is very high. An adequate excision can often be done in the office. A straight line scar is often the result of cyst excisions. The best time to excise a cyst is when it is inflated and palpable but not infected. Cutting out a cyst while it is infected can lead to wound complications such as breakdown of the wound and infection. It also make removal very difficult due to surrounding inflammation, thus the likelihood of complete removal is lower.

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