Many patients are concerned about skin lesions. This concern is usually regarding skin cancer or cosmetic appearance. Your Family Doctor is trained in the evalua tion and cosmetic removal of most skin lesions. This guide will help you under stand which lesions to be concerned about and what office procedures are available for cosmetic removal of any lesion.

Bright red lesions are almost always benign vascular tumors called Cherry Angiomata. Most patients develop them in their thirties. They range in size from pinpoint size to 1/4 inch and many patients develop hundreds of them. They can be removed for cosmetic reasons by electrocautery with minimal discomfort. Rarely, Malignant Melanoma can appear bright red in color. If a bright red lesion grows rapidly (noticeable growth in 1 month), it should be checked by your Family Doctor.

Many rashes are simply a grouping of dull red lesions. However, single dull red lesions can also be cancers or pre-cancers. The pre-cancers are called Actinic Keratoses and appear as flat red scaly patches on the face, neck, shoulders, and hands. They can be frozen with liquid Nitrogen (cryosurgery) to prevent progres sion to skin cancers. The dull red or pink skin cancers are either Basal cell cancers or Squamous cell cancers. They appear as raw skin of irregular texture that won't heal, or lumpy skin or an ulcer that continues to scab over for more than one month. The Basal cell variety are not serious, though untreated they will continue to grow (creating a cosmetic problem). The squamous cell variety can be serious, spreading to other areas. Both can be removed under local anesthesia in the office.

The most common flat brown lesion is the lentigo, commonly called "age" or "liver" spots. They are usually seen on sun-exposed skin areas such as the hands and face, and they are light, medium or dark brown in color. They grow very slowly, but darken with sun exposure. Treatment is difficult, but they can be light ened with bleaching agents and diligent use of sunscreens. Raised brown lesions are usually nevi (common moles) or seborrheic keratoses. Nevi are round or oval and are flesh colored or various shades of brown. They grow slowly and often darken over time. Seborrheic keratoses look like pieces of yellow or brown wax stuck on the skin. They often have a dry cracked surface and may even peel off. Their cause is unknown but often they are inherited. For cosmetic concerns they can be removed by scraping (curettage) or freezing.

Blue or black moles (also called junctional nevi) are common and change very little over time. New blue "moles" and all black "moles" should be evaluated by your Family Doctor. If examination reveals any possibility of malignant melanoma (a serious form of skin cancer), the lesion will be removed in the office. Early detection and treatment is very important with this cancer.

A lump with normal overlying skin is usually either a lipoma (a benign fatty tumor) or a sebaceous cyst (a clogged oil gland). A cyst can become infected (red, sore, and swollen) and may require drainage. A lump with darkened overlying skin may be a dermatofibroma, another benign skin tumor. These lesions can be diagnosed by examination and removed in the office for cosmetic reasons or if a cyst is repeatedly infected.

Spider Veins are networks of tiny blue or purple veins found on the legs. They produce no symptoms but can be unsightly. Fortunately, they can be easily treated in the office by puncturing each vein network with a tiny needle and injecting a concentrated salt water solution. Over the next 3 weeks, the vein collapses and disappears. The procedure is nearly painless. Similar tiny red vessels are found on the face and chest. These lesions are called telangiectasias and can be treated in the office by electrocautery of the central vessel. Both lesions are hereditary or can be caused by estrogen exposure (from pregnancy or birth control pills).

Warts are usually easily recognized by patients. They are caused by viruses and can occur anywhere on the skin, though most commonly on the hands and feet. Warts on the bottoms of the feet are commonly called Planter's Warts. The proper term is "plantar wart" which simply means a wart on the plantar surface (or underside of the foot). They are probably spread by direct or indirect contact. Treatment of warts can be difficult. Although 80% of warts can be cured, the remaining 20% persist regardless of the treatment used. Warts can simply disappear in a year or two without treatment. This has given rise to numerous folk "remedies" (whatever you happened to be doing when the wart disappeared must be the cure). Unfortunately, untreated warts can also multiply, thus complicating treatment. The treatment method depends on the number, size, and location of the warts and the age of the patient. Treatment options are cryosurgery, electrocautery, excision, and applica tion of acids or blistering agents.

Skin tags are benign flesh colored or brown "tags" that hang off the skin. They are usually located around the neck, in the armpits or groin, or under the breasts. Most skin tags range from pinhead size to 1/4 inch. Skin tags can be frozen, cauterized, or removed with sterile scissors.

The following procedures are available at Spring Garden Family Practice:

• Cryosurgery (freezing with liquid Nitrogen)
• Electrocautery (burning with a small electric spark)
• Excision (cutting out a lesion followed by suturing)
• Shaving and Curretage (scraping off a lesion)
• Chemical cautery (burning or blistering lesions with a chemical agent)

Malignant Melanoma is the serious, potentially fatal skin cancer. It most often appears as a black mole. Early detection and removal is essential for cure. The appearance of Malignant Melanoma is summarized by the following ABCDs:

• Asymmetry--the lesion is not regularly round or oval
• Border irregularity--the borders are notched or indented or have indistinct (blurred) edges
• Color variation--the lesion either has an unusual color (black, blue, or dark brown) or contains multiple shades of black, brown, tan, red, pink, white, or blue
• Diameter--melanomas are larger in diameter than a pencil eraser (0.6 cm) or are growing rapidly

Other important danger signs of Malignant Melanoma are elevation of a previously flat pigmented lesion, surface changes of oozing, crusting, ulceration, or bleeding, or spread of pigment, redness or swelling onto the surrounding skin.

While Malignant Melanoma can occur in anyone, certain factors identify patients who are at increased risk. These risk factors include blue eyes, fair skin, red or blonde hair, excessive sun exposure, a blistering sunburn before age 15, inability to tan, tendency to freckle, or dysplastic moles (dozens or hundreds of irregular shaped or colored moles).

Diligent use of sunscreens, avoidance of excessive sun or UV light (tanning booth) exposure, monthly skin self-exam and evaluation of suspicious lesions by your Family Physician can prevent serious complications of skin cancer.