Skin Tag Removal

Skin tags are soft outgrowths of skin that are non-cancerous in nature. They look like a cluster of skin tissue, formed due to the piling of skin cells. They are prevalent in people who are old, diabetic, obese, have metabolic syndrome, disorders of the skin or with a family history of skin tags. The general statistics show that about 50 to 60% of adults may develop at least one skin tag in their lifetime. It affects men and women equally. The other name for the skin tags is acrochordons.

The benefits of this procedure are:

1. Improved cosmetics to help you enhance your look
2. To reduce the irritation due to rubbing against the clothes or jewellery
3. To prevent the increase in the size of the skin tag
4. To reduce the chances of bleeding and infection
5. Minimal scarring
6. A short procedure with a quick recovery time period
7. Immediate results

You may wish to get skin tags removed if:

1. They are causing irritation 
2. They are bleeding
3. Their appearance is bothering you

If the skin tag is left untreated, it may:

1. Get bigger in size
2. Continue to cause irritation due to constant with the clothes and jewellery

The skin tag removal procedure is generally performed as an outpatient procedure in your doctor’s office. The patients may be given local anaesthesia in the form of a topical application or an injection to reduce the pain. Some of the most commonly used methods of treatment are:

1. Radio cautery 
2. Snip excision
3. Cautery
4. Cryosurgery
5. Nanosecond Q-Switched Nd: Yag or the CO2 laser

The process of skin tag removal may involve the following techniques:

1. Shaving or cutting off the skin tag using a sharp instrument such as a scalpel (example: Snip excision)
2. Freezing the skin tag using extremely cold gas like liquid nitrogen (example: cryosurgery)
3. Burning the skin tag with heat from electric energy or radio waves (example: cautery or radio cautery)

Your doctor will evaluate your condition carefully and choose the best method for you, depending on the location of your skin tag and your medical history. You may be inquired about the following:

1. The medications you are taking, if any, including prescription and over-the-counter medications
2. Any herbal supplements you are taking
3. Your family and medical history to find out the cause of the skin tag

On the day of surgery, you can expect the following:

1. A healthcare professional will get a consent form signed.
2. Your doctor will evaluate the number of skin tags to be operated on and choose from the list below:
   1. Lidocaine 1% injection as local anaesthesia to numb the area
   2. Topical anaesthesia to be applied to the area, especially for the paediatric (children) population
   3. Ice cubes to numb the area
3. Healthcare staff will position you in a comfortable position for visibility and accessibility to the doctor.
4. A nurse will wipe the area of the skin tag with alcohol.
5. Next, the skin tag may be pre-treated with aluminium chloride if needed (e.g. Method: excision).

You may expect the following during the procedure:

1. Snip excision (simple excision):
   1. The skin tag lesion will be wiped and cleaned with alcohol.
   2. Your doctor will hold the tag with pickups.
   3. Then, using curved scissors, your doctor will snip (cut) around the stalk of the skin tag.
   4. A curette will be used to scrape off any remnants of the skin tag.
   5. This method mostly does not need any stitches.
   6. Your doctor will use medicines or a cautery method to seal the blood vessels to stop bleeding.
2. Shave excision:
   1. The area will be numbed using one of the local anaesthesia methods.
   2. Your doctor will use a small blade to shave off the outermost layer of the skin along with the lesion.
   3. This method does not require stitches.
   4. Your doctor will apply some medicines to stop the bleeding.
   5. In case the medicine doesn’t work, the cautery method may be employed to seal the blood vessels.
3. Electrodesiccation or cautery:
   1. Your doctor will use an electrode as a cutting blade. 
   2. Your doctor will grasp the skin tag using a pickup.
   3. Then, an electrode will be placed on the skin tag to destroy the tag.
   4. The same electrode might be used to seal the blood vessels as well.
4. Cryosurgery: This may be performed using one of the following methods:
   1. Cotton swab method – Your doctor will dip a cotton swab in liquid nitrogen and apply it to the skin tag to freeze the skin tag and remove it.
   2. Spray method – A steady stream of liquid nitrogen will be applied 1-1.5 cm away from the skin tag until the skin tag freezes and gets removed.
   3. Pickup method – The base of the skin tag will be held using a pickup dipped in liquid nitrogen. It will be held until there is a formation of a ball of ice to freeze it.

All these methods are repeated until the skin tag gets removed. The technique is repeated after the treated skin tag is left to thaw.

Some of the things that you can expect after the procedure are:

1. Your doctor will check and enquire about any symptoms that may indicate an infection.
2. For very small tags, you may not have any after-care instructions at all.
3. You may expect the following after these procedures:
   1. Excision:
      1. You will be asked to wash and dry the area every day.
      2. You will be advised to apply antibiotics to the wound.
      3. You may be allowed to apply a band-aid if needed.
   2. Electrosurgery:
      1. You may have stitches in the area, and so there may be a scar.
      2. You will be asked to clean the area with antibiotics to prevent any infections due to an open wound.
   3. Cryosurgery:
      1. The skin tag will dry and fall off at home.
      2. You will be asked to wash and pat the area dry.
      3. You may use a band-aid if needed

Removal of skin tags is generally a low-risk procedure. However, any kind of surgical procedure involves some risk associated with it. Hence, some of the possible complications of the skin tag removal procedures are:

1. Post-surgical infection
2. Excessive bleeding from the area that requires treatment with silver nitrate or electrocautery to coagulate the blood

There could be some side effects post-surgery like:

1. Slight irritation at the site of skin tag removal, sometimes leading to irritant dermatitis (skin reactions caused due to the contact with an irritating substance).
2. Scarring due to improper removal of skin tag
3. If the procedure is not performed by an experienced professional, then there are chances of normal skin being removed along with the skin tag leading to disfigurement.
4. Very rarely, there are chances of the development of neuroma (disorganised growth of nerve cells) when a nerve gets cut while removing a skin tag, resulting in long-term pain for a few weeks to months.