Skin Lesion: To Remove or Not to Remove?

If you’re on the fence about removing skin lesions, you’ve turned to the right page!

Spots on your skin can develop at any stage of life. It could be due to your genes, age or environmental factors like exposure to the sun.

These spots are skin lesions or better known as age spots, moles or skin tags to name a few. They appear at any area on your body and while some embrace these spots as a unique feature, others might find that it kills their confidence. On top of that, one should also note that some skin lesions could be a sign of a more serious health condition.

Consultant Aesthetic Physician, Dr. Amelia Siah from A Glow Clinic goes in-depth about skin lesions and your treatment options if you’re planning on removing them.

Dr. Amelia Siah, Consultant Aesthetic Physician, A Glow Clinic

1Twenty80: What are benign pigmented lesions?

Dr. Amelia Siah: Brown or black spots on your skin are sometimes called pigmented lesions. Examples include moles, age spots and sun damaged skin. A skin lesion may be classified as benign (non-cancerous), pre-malignant or malignant (cancerous).

Most skin lesions such as moles and skin tags are benign. A pre-malignant or pre-cancerous skin lesion carries an increased risk of cancer. Malignant skin lesions must be treated immediately.

It is important to diagnose which category the lesion belongs to. A professional aesthetic doctor or dermatologist can provide an accurate diagnosis based on the appearance of the lesion and the patient’s clinical history. Based on this, a biopsy performed by a dermatologist may be requested to determine if the lesion poses any cancer risk.

Benign lesions can generally be left alone, if it does not bother you in any way. Any change in colour, shape or size of the lesion should be evaluated by a dermatologist immediately. If a lesion is new, starts bleeding or is painful, it can be a sign of cancer or a pre-cancerous lesion and should be checked immediately.

1Twenty80: Why do they develop?

Dr. Amelia: There are different types of skin pigmentation which can develop due to congenital (at birth) or acquired causes.

Those that develop due to congenital causes include birthmarks or freckles that are more prominent during the adolescent phase, mainly due to genetics.

Acquired pigmentations include solar lentigo (sun spots), melasma (mask-like pigments due to UV and hormonal changes), hori’s nevus (on the cheeks), post-inflammatory hyperpigmentation and others.

Some benign pigmented lesions do result in cosmetic or  psychological concerns to the patient, which prompts them to seek out appropriate treatments to remove them.

1Twenty80: How can one tell the difference if the lesion is benign or cancerous?

Dr. Amelia: I typically follow the ‘ABCDE’ rule when making an assessment, which is:

  • A – Asymmetry; cancerous lesions appear asymmetrically
  • B – Border; cancerous lesions have irregular borders
  • C – Colour; cancerous lesions have uneven colour
  • D – Diameter; cancerous lesions are usually larger than 6mm
  • E – Evolving; cancerous lesions evolve into the above in a short duration

1Twenty80: Why do people choose to remove pigmented lesions?

Dr. Amelia: Some benign pigmented lesions do result in cosmetic or psychological concerns to the patient, which prompts them to seek out appropriate treatments to remove them. From my experience, patients have different reasons for choosing to remove pigmentations, such as:

  • Low confidence due to the ‘dirty appearance’ of the skin
  • Concerns about skin health
  • A desire for flawless skin

1Twenty80: What are the removal options available?

Dr. Amelia: There are multiple ways to remove benign pigmented lesions including:

OVER-THE-COUNTER (OTC) AND PRESCRIPTION ORAL MEDICATION/ TOPICAL SKIN CARE PRODUCTS – The effectiveness of these vary. Doctors can prescribe oral medication or supplements that can reduce pigmentation. OTC products are usually used as ‘at home’ regiments to maintain the good results from a clinical treatment.

CHEMICAL PEELS – A chemical peel is a technique that utilises a chemical solution to ‘peel off’ the topmost layer of the skin, removing skin discolorations and promoting new skin growth. Peels can be used to improve the appearance of acne scars, melasma, sun damaged skin, wrinkles and to lighten dark spots. Chemical agents used in chemical peels remove the melanin layer of the skin; and the effectiveness of the treatment is determined by its concentration, number of coats and the duration of application. However, there is a risk of developing adverse effects such as post-inflammatory hyperpigmentation (PIH) with chemical peels, and individuals with darker skin tones are at higher risk of PIH. Patients should consult a dermatologist or aesthetic physician to determine if chemical peels are suitable for their skin condition.

LASER BASED TREATMENTS – Laser treatments use a specific wavelength to target and destroy the selected cells. For example, picosecond lasers use advanced laser technology for the treatment of pigmented lesions. The energy from the laser will penetrate through the outer layer of skin, directly targeting and destroying the lesion without affecting the surrounding tissues. This makes it safer and minimizes damage to the surrounding skin and tissues. It breaks down the pigmented particles into granules, which are then easily eliminated by the body’s immune system. The right wavelength, intensity and duration of treatment has to be accurately determined in order for the treatment to be effective and without side effects.

INJECTABLES – Such as lightening agents or hydrating agents, can help to reduce the appearance of pigmentation and scars.

I would like to add an important note here on sun protection. Sun protection or sunblock is very important in maintaining your skin and blocking the ultraviolet rays that can cause photoaging. It comes in oral pills or topical products, and we should ensure that it comes with a minimum of SPF 30++. Prevention is always better than cure.

1Twenty80: Is there a risk of scarring after the lesion has been removed?

Dr. Amelia: When done correctly and by a trained professional, the patient is unlikely to experience any scarring or post- inflammatory hyperpigmentation (PIH) after removal of a lesion. Some laser devices are able to directly target the affected cells without causing any damage to the surrounding skin or tissues, making it safer and less likely for the patient to develop scarring/PIH.

1Twenty80: Lastly, what are some of the mistakes people tend to make when it comes to removing these lesions and its dangers?

Dr. Amelia: It’s important to address your skin concerns with a suitably qualified professional, such as an aesthetic doctor or dermatologist, who is certified by the local Ministry of Health (MOH). Many patients visit beauty salons that offer similar laser treatments, instead of visiting a MOH-registered clinic, due to cheaper costs or lack of awareness.

Only MOH-licensed clinics with aesthetic credentials are allowed to carry out laser treatments. Laser treatments, like many other aesthetic procedures, should be operated by properly trained and experienced professionals, in order to minimise the side-effects and risks to patients, and ensure best treatment outcomes.

The qualifications and experience of the aesthetic doctor is also an important factor, as unlike beauticians, we are well trained to operate these medical devices. A clinic that uses reputable brands like Discovery Pico, which are recognised internationally and backed by research, is also another important criteria as there are many counterfeit/copycat products in the market these days that may not deliver the results you are hoping for.