Skin lesions

"Skin lesion" is a broad term for any abnormal area of skin - a lump, a patch, a growth or a mark that differs from the skin around it. It covers everything from a harmless mole to a skin cancer, which is exactly why the word on its own tells you nothing useful.

The useful question is not "how do I get rid of this lesion" but "what is this lesion". The answer determines both whether it should be removed and how.

Common benign lesions

• Moles (naevi) - clusters of pigment-producing cells, flat or raised
• Seborrhoeic keratoses - raised, waxy, "stuck-on" growths of later life
• Skin tags - soft growths on a stalk, at sites of friction
• Cysts - fluid- or keratin-filled lumps beneath the skin
• Lipomas - soft fatty lumps under the skin
• Dermatofibromas - firm, small nodules, often on the legs
• Cherry angiomas and haemangiomas - benign vascular lesions
• Milia - tiny white keratin cysts, commonly around the eyes
• Warts - viral, caused by HPV
• Birthmarks

Lesions that are not benign

• Solar keratoses - precancerous
• Basal cell carcinoma, squamous cell carcinoma and melanoma

Several of these look like the benign lesions above. A pigmented basal cell carcinoma can pass for a mole; a melanoma can pass for a seborrhoeic keratosis; a squamous cell carcinoma can pass for a persistent scaly patch.

Assessment comes first, always

A lesion is examined clinically, with dermoscopy where appropriate, before any decision about removal. Where there is doubt, the lesion is excised whole and sent to pathology.

This matters because laser, cryotherapy and radiofrequency all destroy the tissue. If an unassessed lesion is removed that way and it was a cancer, there is no specimen, no diagnosis, no confirmation that the margins were clear, and nothing in your record showing it existed. A recurrence years later then arrives with no history behind it.

This is the governing rule across our skin services, and we will say no to destroying a lesion that ought to be tested.

When to have a lesion looked at without delay

• It is new in adulthood, or growing
• It has changed in size, shape, colour or texture
• It has more than one colour, or an irregular border
• It bleeds, crusts, itches or is tender
• It is a sore that has not healed within a month
• It looks different from all your other spots

How lesions are removed

Method	Typically used for	Leaves tissue for pathology?
Surgical excision	Anything suspicious; deeper lesions; cysts and lipomas	Yes - the whole lesion
Shave excision	Raised benign lesions	Yes - the shaved portion
Curettage	Superficial benign growths, e.g. seborrhoeic keratoses	Yes - the curetted tissue
Radiofrequency (electrosurgery)	Raised benign lesions, skin tags	No
Laser	Flat benign pigmented and vascular lesions	No
Cryotherapy	Assessed benign lesions, solar keratoses	No

The third column is the reason method selection is a clinical decision rather than a preference. Where a lesion needs to be diagnosed, only the top three rows are appropriate.

Most lesion removals are done under local anaesthetic as a day procedure at our Malvern East clinic. Larger excisions, and those needing reconstruction, are performed by our Specialist Plastic Surgeons.

Aftercare

• Keep the wound clean and dry; follow the dressing instructions
• Do not pick scabs
• Avoid heavy lifting and stretching of the area where an excision has been closed with sutures
• Attend the suture removal appointment where non-dissolvable sutures were used
• Protect the site from sun for several months, then use sunscreen
• Contact us if there is increasing pain, redness, swelling or discharge

Risks

• Scarring - permanent with excision, possible with any method
• Changes in pigmentation at the site
• Infection
• Bleeding and bruising
• Wound separation or delayed healing
• Numbness or altered sensation
• Keloid or hypertrophic scarring in those prone to it
• Distortion of a nearby feature where a lesion sits at an eyelid, nostril, lip or ear
• Incomplete removal and recurrence
• Missed diagnosis where a lesion is destroyed rather than examined

See risks and complications.

Cost and Medicare

Cost depends on the lesion, the site, the number and the method. As at September 2024 and including GST, a consultation with a Cosmetic Doctor is $150 and with a Specialist Plastic Surgeon $350.

Removal for cosmetic reasons is not covered by Medicare. Removal that is medically indicated - a suspicious or symptomatic lesion - may attract a Medicare rebate. Me Clinic is not a no-gap provider, so an out-of-pocket cost will usually apply.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: mole removal guide, skin cancers, all skin conditions.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.