Diagnostics and treatment of skin lesions

Diagnostics and treatment of skin lesions

Skin lesions are defined as any abnormalities on the skin’s surface. Most of these abnormalities are only a cosmetic defect of the skin without any clinical significance. However, a small percentage can be oncogenic and lead to the development of a neoplastic disease. The number of skin lesions increases with age. There is a great variety of skin lesions, varying in colour, shape, size, convexity, surface type. However, the type of medical treatment is primarily determined by the type of cells they develop from, which can be assessed in a histological examination. They can be of cellular, pigmentary, vascular, viral or other nature.

It is necessary to consult a dermatologist before starting any therapy for skin lesions.

Laser-based removal of skin lesions can only be performed in cases where a dermatologist has excluded the oncogenic nature of such lesions. All other cases require a conventional surgical procedure, maintaining a suitable safety margin and conducting a histopathological examination. The Healthy Skin Centre employs a team of specialists in both dermatology and plastic surgery. Moreover, we offer the possibility of histopathological examinations, thereby ensuring a comprehensive service to every single patient.

The removal of skin lesions using the CO2 laser is a quick and pain-free method. The laser is an excellent surgical tool applicable in the field of aesthetic dentistry. A great advantage of the laser is the contactless operation that guarantees complete cleanliness of the surgical field. Another important aspect includes significant reduction of bleeding and immediate coagulation. With these advantages, the procedures are more precise and the recovery period is minimised.

Depending on the depth and size of the lesion, it can be evaporated using the laser beam working in different modes. After coming into contact with a hydrated pathological tissue, the laser evaporates the tissue without causing any bleeding. At this stage, fibromas and other skin lesions are removed. On the following day, the evaporation site is covered with a superficial brown crust.

The CO2 laser helps us remove such marks as: fibromas, ruby angiomas, viral verrucae (warts), genital warts (pointed condylomas), certain moles, scars and other skin outgrowths.

Types of skin lesions:

  • Pigmented moles – congenital skin irregularities, emerging at various stages of one’s life and transforming under the influence of diverse factors, e.g. hormones, UV radiation.
    •  Epidermal moles
      • Flat moles – not enlarged above the level of the skin and cause no discomfort. They become bigger as the child grows. As a result of chronic irritation, they might develop into a malignant skin cancer – melanoma. However, this happens very rarely.
      • Lentigines – fine, well-delineated spots characterised by a light- or dark-brown colour. They are usually numerous, most often affecting the torso, and appear in childhood. They look like freckles, but are slightly bigger. Solar and senile lentigines emerge under chronic solar radiation exposure or in the course of PUVA therapy, or in elderly individuals particularly of light complexion which is difficult to tan.
    • Cellular moles
      • Blue moles – smooth, hairless moles usually of a small diameter, located deep in the skin, typically on the face and limbs. Their colour ranges from light blue to black. They are harmless.

        The congenital variety of pigmented moles – usually of a large size, sometimes with an irregular, wart-like surface which tends to be hairy. Even though these features are deemed to be safe, congenital moles often become malignant.
  • Keratosis (senile and actinic) – this mostly refers to multiple yellow-brown skin lesions, with dry, uneven surface adhering closely to the skin. They lie at the level of the surrounding skin or are only slightly raised. They result from chronic sun-related damages to or senility of the skin. The most commonly affected body area is the face and other exposed parts (e.g. the bowl of the ear, the back of the hands, forearms and lower legs). They occur primarily in individuals aged 40 and more. Cornification (keratosis) may become a starting point for skin cancers.
  • Fibromas – benign tumours that are composed of fibrous or connective tissue.
    • Soft fibromas – congenital in nature; however, they can also appear in people of different ages. Soft fibromas are sack-like hanging tumours, usually numerous, having the colour of the skin or slightly darker, brownish hues. They are particularly common on the neck and nape, especially in elderly women. They are typical of Recklinghausen's disease.
    • Hard fibromas – in fact, a fibrous reaction and occur regardless of age. They are usually single in nature, tinier and mainly located on the limbs. They appear in middle-aged and elderly patients.
  • Lipomas – nodules of various sizes composed of subcutaneous adipose (fatty) tissue. They shift in relation to their ground and often occur in multiple locations, primarily in young or middle-aged women. Lipomas are the result of focal hypertrophy of fat cells to form nodules or tumours, sometimes of a large size. The lesions mainly affect the torso, the nape of the neck, buttocks, arms and forearms. They do not pose oncologic risks, but may grow, causing pressure and discomfort.
  • Atheromas – epidermal cysts that develop due to blockage of secretion from the sebaceous glands within hair follicles. They consist of a sack and a white atheromatous substance with a characteristic unpleasant odour. The size of atheromas can vary from a few millimetres to several centimetres. Their location varies considerably, the most common being the scalp, the back, the face and the scrotum. The lesions can be extensive. The skin has inflammatory changes, with an occasional plug on the top that resembles a comedo.
  • Seborrhoeic (senile) warts – they belong to the group of epidermal lesions and are in fact benign epidermal neoplasms of flat, raised and papillary structure. Their colour ranges from the tint of the skin to brownish hues. They are most commonly present on the torso, face and backs of the hands. They emerge in mature and elderly individuals. Dissemination of multiple lesions on the torso may sometimes indicate neoplasms of internal organs and, in some cases, digestive track cancers or other carcinomas.
  • Common warts – epidermal papulae with rough surface and the size of 5-10 mm, located primarily on the skin of hands, fingers, nail folds, and sometimes under nail plates. They are associated with HPV-2 infection, as well as HPV-4 and HPV-7 infections.
  • Plantar warts – located on the sole (planta) of the foot, have a rough surface and the colour of the skin, and can grow up to 1–2 cm. There are two types of plantar warts: deep and disseminated, as well as more superficial ones, which concentrate into clusters forming the so-called mosaic-type warts. Deep warts are often painful and can make walking difficult. The trigger factor of deep warts is the HPV-1 virus, while mosaic-type warts are caused by the HPV-2 virus.
  • Plane warts (juvenile verrucae planae) – slightly raised, with smooth surface and the size of a few millimetres, sometimes assuming a linear arrangement in the scratched area. They emerge on the face and the back of hands, as multiple papulae with a smooth surface and a grey colour. The pathogenesis of plane warts is associated with HPV-3 viruses, less frequently with HPV-10.
  • Transient warts – cutaneous eruptions sharing certain similarities with common warts and plane warts. They are common in immunocompromised patients.
  • Vascular coccus – angioma associated with capillary neoplasia caused by an injury and/or bacterial infection. The nodule is usually singular in nature, with a livid red colour, a damp and easily bleeding surface and a peduncular structure. It has a high growth rate and often appears in pregnant women or as a complication of oral isotretinoin therapy. The most common body part affected are the face and the arms. This lesion is painful.
  • Xanthomas – pale yellowish papular lesions most commonly occupying the areas of eyelids and occurring in middle-aged and elderly individuals. Initially, their most frequent location is the upper eyelids. Later on, they usually spread to the lower eyelids. They are often asymmetrical, with the bigger ones on either side. They are usually associated with the deposits of cholesterol in the skin.

Proposed therapies:

  • CO2 laser

 

Centrum Zdrowej Skóry The Healthy Skin Centre ul. Racławicka 27 02-601 Warsaw Centrum Medyczne Damiana Polskie Towarzystwo Lekarzy Medycyny Estetycznej POLME

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