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The causes of appearance or change of a skin lesion
- 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 an atypical lesion: a change in shape, colour or size, bleeding or ulceration requires closer evaluation, as some skin cancers (carcinoma, melanoma) can present in this way.
Some of these phenomena are entirely normal and evolve over time. The goal of the examination is to identify the nature of the lesion (benign, inflammatory, infectious or suspicious) and to adapt the course of action.
Possible solutions
Depending on the cause and the wishes of the patient, several options may be considered. Two main categories of procedures are generally distinguished: aesthetic / dermatological medicine and surgical procedures.
Aesthetic medicine / dermatology
- Cryotherapy: application of controlled cold 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 necessary depending on the nature and depth.
- Electrocoagulation / radiofrequency: local destruction using electrical current for superficial growths (fibromas, small keratoses).
These techniques often aim to reduce or remove the lesion, with a variable risk of scarring 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. It is an essential diagnostic procedure to guide management.
- Surgical excision under local anaesthesia: complete removal of a lesion, with the specimen sent to the 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 makes it possible to obtain a definitive diagnosis and, where appropriate, to treat the lesion completely.
Management pathway
- Initial consultation: clinical examination of the lesion, dermoscopic examination if available, medical history taking, photography and discussion of expectations and risks.
- Proposal of a suitable plan: surveillance, non-invasive medical procedure, biopsy or surgical excision depending on whether the lesion is benign or suspicious.
- Information and consent: explanation of the alternatives, the possible complications (bleeding, infection, scarring) and the post-operative course.
- The procedure itself: in consultation or in the operating theatre depending on complexity; local anaesthesia in most cases. Specimen sent for histopathology if a histological examination is required.
- Follow-up: post-procedure appointment to check healing, communication of the analysis results and organisation of further monitoring if needed.
Expected results and follow-up
Realistic goals are diagnostic clarification (by biopsy/histology), removal or reduction of the lesion, and harmonious healing. Results vary depending on the nature of the lesion, the technique used and individual healing capacity. Some non-surgical techniques require several sessions and carry a risk of recurrence. Regular monitoring may be offered to watch for the appearance of new lesions or the long-term evolution, particularly after excision of a suspicious lesion.