The causes of appearance or change of a skin lesion are varied:
- Benign and chronic factors: skin ageing, accumulated sun exposure, repeated friction, local viral infections (warts).
- Congenital or genetic factors: certain moles or patches present since childhood.
- Inflammatory or traumatic factors: scars, inflammatory cysts.
- Suspicion of atypical lesion: a change in shape, colour, size, bleeding, or ulceration requires closer evaluation as some skin cancers (carcinoma, melanoma) can present in this way.
These phenomena are, for some, entirely normal and evolving. The goal of the examination is to identify the nature of the lesion (benign, inflammatory, infectious, or suspicious) and to determine the appropriate course of action.
Possible Solutions
Depending on the cause and the patient's wishes, several options may be considered. Two main categories of procedures exist: aesthetic/dermatological medicine and surgical procedures.
Aesthetic Medicine / Dermatology
- Cryotherapy: controlled cold application to destroy superficial lesions (e.g. warts, actinic keratoses). Usually performed during consultation, sometimes over several sessions.
- Laser or light treatment: treatment of vascular lesions (angiomas, telangiectasias) or targeted destruction of certain superficial lesions. Several sessions may be required depending on nature and depth.
- Electrosurgery / radiofrequency: local destruction using electrical current for superficial overgrowths (fibromas, small keratoses).
These techniques generally aim for reduction or elimination of the lesion, with a variable scar risk depending on the method and the area treated.
Surgery and Diagnostic Procedures
- Skin biopsy: partial or complete sampling for histopathological examination when the nature of the lesion is uncertain or suspicious. This is an essential diagnostic procedure to guide management.
- Surgical excision under local anaesthesia: complete removal of a lesion with systematic submission to histopathology laboratory if necessary. Indicated for suspicious lesions or those requiring analysis.
- Repair techniques: simple closure, scar revision, or local reconstruction depending on the size and location of the excision. Surgery provides a definitive diagnosis and, where appropriate, complete treatment of the lesion.
The Care Process
- Initial consultation: clinical examination of the lesion, dermoscopic examination if available, history taking, photography, and discussion of expectations and risks.
- Adapted plan proposal: surveillance, non-invasive medical procedure, biopsy, or surgical excision depending on whether the lesion is benign or suspicious.
- Information and consent: explanation of alternatives, possible complications (bleeding, infection, scar), and post-operative course.
- Procedure: in consultation or in theatre depending on complexity; local anaesthesia in most cases. Submission to histopathology if histological examination is required.
- Follow-up: post-procedure appointment for healing check, communication of analysis results, and organisation of ongoing monitoring if needed.
Expected Results and Follow-up
Realistic goals are diagnostic clarification (by biopsy/histology), elimination or reduction of the lesion, and harmonious healing. Results vary depending on the nature of the lesion, the technique used, and the individual's healing capacity. Some non-surgical techniques require several sessions and carry a risk of recurrence. Regular monitoring may be offered to track the appearance of new lesions or long-term evolution, particularly after excision of a suspicious lesion.