How to remove Seborrheic Keratosis, and what should I expect during removal? (photo)

Thanks for the question. Seborrhoeic keratosis is a benign growth and it usually appears with age.

Seborrhoeic keratosis can be removed by electrosurgical ablation. A local anaesthetic injection is given before the procedure to minimize the pain. For smaller lesions, a numbing cream may be applied before the procedure.

After the lesion is ablated or burnt off, there will be some crusting over the area and the wound may take 1 to 2 weeks to heal. There may be some redness or pigmentation after the wound has healed but this will fade within a 1 to 2 months. The wound generally heals well.

Ablative lasers can also used to ablate the lesion and the outcome is similar to electrosurgical ablation.

Cryotherapy or treatment with liquid nitrogen is also an option. The lesion may develop a blister or scab after the treatment and will 'drop off ' together with the scab. However, the treatment may need to repeated if the lesion still persists after the 1st treatment.

Hi!

Seborrheic keratosis is a benign skin growth that is one of the most common skin growths. Seborrheic keratosis generally increases in number and size with age, and may be related to accumulated sun damage.

How to remove Seborrheic Keratosis, and what should you expect during removal?

There are many ways to remove seborrheic keratosis. Personally, I favor the usage of ultrapulse CO2 laser ablation. This is because it is a very precise and controlled way to make sure the entire seborrheic keratosis is removed in 1 treatment (most of the time).

The ultra-short pulse of CO2 mainly results in ablation with minimal coagulation resulting in minimal collateral damage, reducing the downtime, risk of scarring and post-inflammatory hyperpigmentation (PIH). Other possible treatments can also be used but in my opinion, have certain limitations:

• Electrocautery - tends to have less uniform removal and slightly more collateral damage
• Surgical methods such as curettage or shave biopsy - there might be some bleeding hindering visualization and complete removal
• Cryotherapy with liquid nitrogen - hard to control the depth, may not completely remove the lesion, hence may require multiple treatments
• Focal chemical peel with trichloracetic acid - like cryotherapy, not very controlled

For ultrapulse CO2 laser ablation, firstly strong topical anaesthetic is applied on the area. Local anaesthetic injection may be necessary for patients who are more sensitive to pain or bigger seborrheic keratosis.

The CO2 laser is then used to ablate the seborrheic keratosis. Some burning smell may be present. The procedure is over in 5-10 min and the seborrheic keratosis will be visibly gone immediately after.

There will be a small patch of raw skin (about the same size as the seborrheic keratosis) that crusts over after 2-3 days. The scab will usually fall off after another 3-5 days depending on the size of the original seborrheic keratosis.

It is important to use the prescribed creams and avoid sun exposure, to prevent PIH and scarring.

Generally, ultrapulse CO2 laser ablation of seborrheic keratosis has a good outcome with no scarring and PIH provided proper care is taken.

Do seek a detailed consultation with a doctor who can discuss the various options and give you his experienced opinion.

Hope this helps!

Warmest regards,

Dr Wan Chee Kwang

References

1. Krupashankar et al. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008 Jan;74 Suppl:S61-7.

2. Fitzpatrick et al. Clinical advantage of the CO2 laser superpulsed mode. Treatment of verruca vulgaris, seborrheic keratoses, lentigines, and actinic cheilitis. J Dermatol Surg Oncol. 1994 Jul;20(7):449-56.

Hi,

Seborrheic Keratosis is one of the most common noncancerous skin growths in older adults. The exact cause is unknown. They tend to run in the family, so inheritance may play a role.

There are a few methods for removing seborrheic keratosis. They include electrocautery, cryotherapy and ablative lasers e.g. CO2 laser. CO2 laser ablation of seborrheic keratosis is the method I use as it offers the most precision and control when removing the lesion. This allows for the entire lesion to be removed in a single session(usually) and minimizes risk of scarring and post inflammatory hyperpigmentation.

For CO2 ablation , topical anesthetic is used to numb the area before the procedure. For larger lesions or for patients less tolerant of pain, injection of local anesthetic can be given. Procedure itself generally takes 5-10minutes, depending on size of the lesion.

Post procedure, the seborrhic keratosis will be gone. In its place, there will be a patch of reddish skin similar in size to the original lesion. There will be a light brown mark that may take many weeks to fade away. It is important to use sunblock and avoid sun exposure to prevent PIH.

Hope this helps!

Best regards,
Dr. Soh

Thank you for the question and very clear photo. Seborrheic keratosis are harmless age spots that affect a lot of us as we get older. These are easily removed for cosmetic improvement.

For large raised ones as in the photo, we will usually numb the area with a quick numbing injection or numb cream, before removing using a shave technique.

A little scab will form over a week and then fall off, leaving a light brown discolouration that will fade over a number of weeks.

Some patients have several small seborrheic keratoses and these are treated by light burning.

Again little scabs will form and fall off after a week.

The procedure usually takes no more than 5-10 minutes and is really a quick simple way to restore your skin. Do seek treatment from a doctor or dermatologist with experience with skin surgery or skin procedures for optimal results!

Best regards

Dr Stephanie Ho, Dermatologist

Hi!

Seborrheic keratosis is a benign, non cancerous growth on the skin. All raised lesions that has changed over a short duration of time should still be checked by a doctor before removal.

We use the Ellman surgitron electrocautery system to remove the lesions. It is done under local anaesthetic.

The procedure is relatively quick and we can achieve good clearance in 1 session. Do prepare for 1 week of down time (scabs) and sun avoidance/protection after the procedure. If patient adheres to after care instructions, good recovery can be expected.

Best regards

Dr Yanni