Types of Operation

Intradermal Naevi

These are the lumps that appear usually on the face and many have a few hairs growing out of them. The best operation for these is shave excision. The lump is raised up on a bleb of local anaesthetic then carefully shaved off flush with the skin surface. This gives a smaller, flat pale scar that is barely visible.
Intradermal naevus on forehead
Shaving naevus off with scalpel
After removal
Healed up (1 month later)

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Seborrhoeic warts

These are more common as you get older and rarely seen under the age of 40. They form a rough and slighly greasy brown thickening and can get as large as an inch or two in diameter if left to grow. They can be removed by spraying liquid nitrogen but this is a slow and not very effective method, mainly reserved for multiple lesions. A more effective treatment is to scrape them off with a curette under local anaesthetic. The curette is like a very small spoon but with sharp edges. In fact these lesions often break up when rubbed by clothing and there is no harm in scratching them off with a finger nail although it would hurt somewhat!
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Skin tags

They start small usually around the neck or in the armpits and get more common and larger as you get older. They are easily snipped off with sharp scissors. As a local anaesthetic always stings a bit we find the best way to remove these is to press an ice cube onto them, then when cold and numb, quicky pick them up with forceps and snip them off. An alternative is cover them with the surface anaesthetic EMLA cream which will work for something very superficial like this but not for the bulk of deeper lumps.

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Ingrowing toenails

These cause misery and rarely get better by themselves. They usually occur in teenagers so we have become very adept at treating them with the absolute minimum discomfort possible. The best operation is called a wedge resection where about a fifth of the nail is cut away on both sides. The nail bed then has to be prevented from regrowing again as this would result in further ingrowing within a few months. To stop this happening the traditional method uses a chemical called phenol, which is applied into the nail bed on a bit of cotton wool for about 3-4 minutes. We have moved from this rather crude method and now use an electrical method to prevent nail regrowth that results in a cleaner wound and faster healing.

Ingrowing toenail
After wedge resection & bandage

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Sebaceous Cyst or "Wen"

This is a lump the size of a cherry under the skin usually on the back where the skin is the thickest. It can occur elsewhere and Cromwell famously had a large one on his forehead! It is filled with a cheesy substance made of decomposed skin cells that smells pretty awful and if it touches the hands it takes a lot of washing to remove the smell. The cyst usually connects to the skin via a very fine pore and squeezing will extrude a small amount of the vile smelling contents. To remove it properly is quite tricky as it has a thick walled sack around it which must be completely removed otherwise it will recur.

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These are the hard nodules that are most common on the legs. They often darken in colour to a reddish brown. They are the body scarring around and old insect bite. This is important because it is foolish to try and cut them out as scarring can be severe. instead they are gradually rubbed away with pumice stone making them flatter and less obvious. Certain types of dangerous skin cancer can look a bit like these so it is important with a rapidly growing one to get it medically checked.

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Basal Cell Carcinoma

These are usually treated on the NHS. However there is a very quick and easy way to get rid of small ones in elderly patients called double curettage and cautery. The lesion has to ve less than 5mm diameter. It is then scraped out with a curette and the wound is cauterised with a hot diathermy tip. The wound is once more curetted out and cauterised. This takes a few minutes only and gives a cure rate of over 90%.

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Mole removal and histology

This is available on the NHS at your local surgery if there is any suggestion the mole may be cancerous. However you may want an unsightly or knobbly mole removed and this is readily done by a number of techniques. if it is to be sent for histology then it needs careful removal by elliptical excision with suturing of the wound. Alternatively a mole that has been present unchanged for many years and that sticks up proud can be more easily removed with sharp scissors. Often these appear on the chest in men or women and are actually accessory nipples. it used to be thought of as a sign of a witch!

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Thread veins

These are best treated by microsclerotherapy. We do not offer this service ourselves but a group of French vein specialists run a clinic at Holbrook Surgery and also in London. For more details check out VanishingVeins.com.

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