CURRENT OPTIONS FOR PROCEDURES TO TREAT SK
A Primer on Treatments for SK
If you are thinking about having your SKs treated, a good first step is to make an appointment with a dermatologist to make sure they really are SKs. Getting the right diagnosis is important because SKs and skin cancer can look the same to an untrained eye. A dermatologist can usually diagnose an SK just by inspecting it visually. If the spot looks at all suspicious, he or she will biopsy it, either by shave or excisional biopsy. A biopsy involves removing the lesion, preserving it, and sending it to a pathologist to examine it under a microscope for cancer cells. If your dermatologist tells you that a biopsy is not necessary, you may have other reasons for wanting your SKs removed. (See “Reasons to Treat Seborrheic Keratosis”).
A dermatologist can recommend the best option for you among the various procedures for treating SKs and help you understand any risks associated with treatment. All these procedures should be performed in a doctor’s office by licensed and trained personnel. The good news about treatment is that SKs don’t grow back once they are treated successfully. The bad news is that you may develop more of these lesions over your lifetime, so you may need to seek treatment several times.
If you decide you want your SK lesions removed, your dermatologist may recommend one of the following treatments to you.
What is it? This is the go-to treatment method for most patients, at least light-skinned patients. Two-thirds of seborrheic keratosis patients are treated with cryosurgery. The doctor applies liquid nitrogen with a spray gun or cotton swab to freeze the lesion. Within a week or two, the lesion falls off.
Best for which lesions: Smaller, thinner lesions; multiple lesions; irritated lesions.
Advantages: It’s quick and easy, lasting only a few minutes. It rarely causes bleeding, requires minimal wound care, and has a low risk of infection. It can be the cheapest procedure, especially when removing multiple lesions.
Drawbacks: Liquid nitrogen is – 196 °C, which is about -320 °F. So it’s a painful procedure, producing a stinging sensation that lasts for 10 minutes and may linger for more than an hour for some patients. It’s also an imprecise technique, and it’s difficult to predict how a patient’s skin will react. Sometimes cryosurgery results in permanent hypopigmentation, which is the term to describe lighter discoloration of the skin. This is a particular concern for darker-skinned patients, so this treatment is not recommended for them. It can also cause hyperpigmentation, which is the term to describe darker discoloration of the skin approaching a pinkish-brown hue. Occasionally, it can cause scarring. Multiple treatments a few weeks apart are sometimes required.
Warning. Video may contain graphic content.
What is it? The procedure requires local anesthesia and involves a device with a needle-like metal tip that uses an electric current to “burn” and destroy the tissue.
Best for which lesions: Facial lesions; lesions on highly visible parts of the body; small, thick lesions; lesions on patients with darker skin.
Advantages: It’s precise. The wound generally heals within a week, which is faster than the healing period following cryosurgery. It generally doesn’t cause scarring, bleeding, or hypopigmentation.
Drawbacks: The procedure carries a faint burning smell. It takes several minutes longer than cryosurgery. So if the SK turns up at a routine dermatologist visit that’s already busy with a full-body skin check, your doctor may schedule electrodesiccation for another visit. By comparison, she is more apt to fit cryosurgery into that same visit since it’s quicker. Occasionally, electrodesiccation causes hyperpigmentation.
What is it?: This procedure involves using a metal hand tool with a small scoop at the tip, called a curette, to scrape off the lesion A local anesthetic is injected into the skin before the procedure.
Best for which lesions: Lesions that are thin and less than 2 cm in diameter; multiple thin, tiny lesions.
Advantages: It’s precise. The procedure usually produces a good cosmetic result without any scarring or pigmentary problems. If the lesions are tiny and superficial enough, it often doesn’t cause bleeding either.
Drawbacks: Very small risk of a wound infection if bleeding does occur. Gentle daily washing with soap and water, followed later with petroleum jelly ointment application, is recommended for the week afterward.
Click image to watch a video
Warning. Video may contain graphic content.
Electrodesiccation and Curettage (EDC)
What is it? These two procedures are often used in conjunction with each other. The dermatologist may use electrodesiccation first to soften the lesion, then follow with curettage to scrape it off.
Best for which lesions: Larger, thick lesions; multiple thick lesions.
Advantages: It’s precise. It generally doesn’t cause scarring or hypopigmentation. Healing is faster than cryosurgery’s recovery process.
Drawbacks: The procedure takes longer than cryosurgery. Hyperpigmentation can sometimes result. Bleeding may occur, so there’s a risk of infection. Gentle daily washing with soap and water, followed later with petroleum jelly ointment application, is recommended for the week afterward.
What is it? This method removes the lesion using a scalpel. It requires local anesthesia, which involves an injection into the area before the procedure begins. Though shave removal can be used to biopsy a suspicious-looking lesion, it can also be used for cosmetic purposes only.
Best for which lesions: Raised or thick lesions; suspicious-looking lesions that could be basal cell carcinoma or squamous cell carcinoma.
Advantages: The procedure is quick and doesn’t require suture closure. It usually produces a good cosmetic result with minimal scarring. It is covered by insurance when a biopsy is needed to confirm a diagnosis.
Drawbacks: It can be slightly more expensive than cryosurgery or electrodesiccation. If the treated area is a curved surface, like the nose, it may result in round scars.
What is it? The procedure requires a local anesthetic and uses an intense beam of light that burns and vaporizes the lesion. Different kinds of lasers are used, depending on the patient’s skin type.
Best for which lesions: Small, dark lesions, such as the growths characteristic of DPN (see “Skin of Color and Seborrheic Keratosis”).
Advantages Little pain or bleeding. Quick recovery time. It gives excellent cosmetic results in the case of DPN.
Drawbacks: Not all dermatologists have the right lasers for doing this procedure. Even if they do, setting up the laser is time-consuming. That’s a big reason why doctors avoid using it when other treatments are quicker and equally or more effective. Topical anesthesia may be required and there’s also a risk of scarring and hypopigmentation, especially if a CO2 laser is used. Removing SK lesions with a laser is more expensive than the other treatment approaches.
What is it? This procedure involves applying a chemical solution to the entire face to make the top layer peel away and expose the skin underneath. When one of the purposes of the peel is to remove SKs, the doctor generally applies either glycolic acid at a high concentration, such as 70%, or trichloroacetic acid (TCA) as the peeling agent. The solution is left on for several minutes and then neutralized.
Best for which lesions: Typically used for thin lesions on the face.
Advantages It has other benefits, such as reducing the signs of sun damage and improving the appearance of skin.
Drawbacks: It has limited effectiveness and will not remove thicker SKs. Skin will be red or swollen after the procedure for awhile, but it’s hard to predict how each patient’s skin will react. Skin is sun-sensitive afterward, so diligent sunscreen use is crucial. A series of peels may be needed to achieve the best results so it can be more expensive than other options.