Common Superficial Lesions

Some of the most common questions that patients ask dermatologists concern skin lesions. Skin lesions are remarkably common and the overwhelming majority of them are benign. However where such lesions occur on the face they can be unpleasant and cause distress to many people. Among the most common of such lesions are Seborrheic and Actinic Keratoses, and nevi (moles).

What Is It?

Of all superficial lesions seborrheic keratoses are the most common. The exact cause of seborrheic keratoses is unknown but they are most common on the sun-exposed areas of older patients, especially on the face, neck and trunk. Seborrheic keratoses are usually a brown-black color and may appear crusty or wart-like. It is not uncommon for them to ooze and bleed when irritated. Many people often mistake seborrheic keratoses for skin cancer or melanoma. Seborrheic keratoses are however completely benign with no malignant potential. Nevertheless many people choose to have them removed for aesthetic reasons. Since they are superficial they can be removed relatively easily.

Actinic Keratoses are flat, pink, scaly lesions that can develop in sun-exposed areas and are more common in fair skinned patients whose skin has been exposed a lot to the sun. They are most common on the ears, forehead hands neck, and nose. Over time, actinic keratoses can get bigger, thicken, and occasionally become cancerous.

Actinic Keratoses can remain unchanged for years. However they can eventually thicken, itch, and occasionally bleed. When this happens these are signs that the lesions are becoming malignant. Approximately 1 in 50 actinic Keratoses become cancerous.

Nevi are more commonly known as moles. Moles can appear on their own or in clusters, and are usually harmless collections of pigmented cells called melanocytes. They can appear alone or in multiples. Moles are more common on the head, neck and torso and they can vary enormously in terms of size, shape, color and the amount of hair present. Moles can also be present in more obscure locations. Most of us have between 10 to 40 moles. They usually appear between the ages of 2 and 20 and some may disappear with age. Although many people are concerned about moles most rarely become cancerous. Nevertheless it is important to become familiar with the moles on your skin and if you have any concerns about them to see a dermatologist.

Traditional Treatment

The most common treatment for keratoses and moles is surgical excision. With acticnic keratoses and moles your doctor may take a tissue sample in order to carry out a biopsy to test whether it is cancerous or not.

Freezing keratoses with dry ice or liquid nitrogen avoids the need for surgical excision; however, complications of freezing include pigment changes and rarely scarring.

The treatment of most moles usually isn't necessary although some people may wish to have them removed for cosmetic reasons. The most common treatments include:

- Shave excision. In this method, the area around the mole is numbed using a local anesthetic and then a small blade is used to shave off the mole close to your skin
- Punch biopsy. Using a device that looks like a cookie cutter your doctor may remove a mole with a small incision or punch biopsy technique.
- Excision surgery. The mole and a surrounding margin of healthy skin are removed using traditional surgery.

All of these procedures can usually be performed in your practitioner's office and do no take much time. However the results of these treatments range from fair to minimal, with recurrences sometimes occurring.

Fotona Laser Treatment

Fotana's FET Fractional Erbium Technology

Laser ablation of keratoses allows for the removal of the epidermis and superficial dermis in a controlled and relatively bloodless manner. Clinical studies have shown that the Er:YAG laser is a very effective treatment for keratoses with a clinical and histological improvement of up to 93% after one treatment, and without significant side effects.

Laser treatment of moles works by targeting the melanin pigment found within the mlanocytes of the moles. Laser treatment of moles is usually progressive often requiring multiple treatments. About 70% of patients who have laser treatments to remove their moles notice a marked improvement. Newer and shallower moles and scars respond better than older and deeper scars and moles.

Additional studies show that the appearance of moles continues to improve after the treatment, usually between 3 to 6 months after the treatment was given.

Before & After

BEFORE	AFTER

BEFORE	AFTER

BEFORE	AFTER