Methods of nevus removal in children and adults

A nevus is a benign spot or growth of congenital or acquired origin. Neoplasms can have different shapes and sizes and range from flat spots to large papilloma-like elements. Most of these formations are not dangerous to the patient's health, but can cause some inconvenience, both aesthetic and functional. In addition, some of them can degenerate into melanoma - a malignant tumor. For these reasons, in some cases the doctor prescribes nevus removal. [ 1 ]

Nevus removal quota

The cost of nevus removal varies not only depending on the region. Other factors such as the type, size, and location of the neoplasm are also important. The final price is affected by the number of sessions, the complexity of the intervention, the use of painkillers and other medications, and the need for subsequent recovery after the operation. Of course, all treatment procedures justify the amount of money spent and allow you to get rid of the dermatological problem, but it is often the financial side of the issue that keeps patients from visiting a doctor in a timely manner. Many people have a question: is it possible to remove a nevus for free? Sometimes this is really possible if the pathological element is removed not for aesthetic reasons, but for medical reasons. The patient should visit his or her attending (family) doctor, get a referral to a specialized specialist (dermatologist-oncologist or surgeon), who will give an opinion and, in order of priority, refer for the procedure. This possibility is assessed on an individual basis.

Indications for the procedure

Removal of a nevus is indicated in the following cases:

• if the problematic element is located in an area with a high probability of damage - for example, in places where clothing and shoes rub, on the fingers and toes, on the head or neck;
• if the presence of a nevus has a negative impact on the aesthetics of appearance - in particular, removal of a nevus is often necessary when it is localized in the face or décolleté area;
• if the neoplasm is injured, behaves suspiciously, or grows rapidly.

Contact your doctor immediately to have the nevus removed if [ 2 ] it:

• begins to darken or change color;
• the perimeter becomes inflamed and a red rim appears;
• from previously flat becomes bumpy;
• accelerates its growth;
• becomes covered with cracks or ulcers;
• makes itself known by unpleasant sensations such as pain, tingling, itching, a feeling of pressure and distension;
• starts to bleed.

Preparation

Before removing a nevus, the doctor examines it and, if necessary, conducts a more thorough examination - for example, performs a dermatoscopy. It is also important for the specialist to make sure that the patient has no contraindications to the removal procedure.

The scale of preparation for removal depends, first of all, on the method of anesthesia that is supposed to be used. If the intervention is to be performed under general anesthesia, it is important that the stomach is empty at the time of the operation, because even a minimal amount of food or water in the stomach can pose a real threat to the patient's life.

Before any nevus removal, it is advisable to take a shower, since after the intervention, water procedures will be somewhat limited. The day before the operation, the doctor should be informed about what medications the patient takes on a regular basis. It is necessary to stop taking medications that affect blood clotting in advance - in particular, anticoagulants, antiplatelet agents (acetylsalicylic acid, Cardiomagnyl, Aspecard, etc.).

In general, nevus removal does not require any specific preparatory measures. It is important to follow all the doctor's recommendations, and the intervention will be as comfortable and without complications as possible.

Technique nevus removal

Today, the most common methods are cryodestruction (freezing with liquid nitrogen), electrocoagulation, as well as laser, radio wave and surgical removal of the nevus. In the latter case, local anesthesia is used: the surgeon excises and removes the pigmented element with the capture of nearby healthy tissue, after which he sutures the wound. The intervention area is covered with an aseptic dressing. Unfortunately, a scar invariably forms at the site of the operation. Large neoplasms are excised in stages, but quickly, since partial resection significantly increases the risk of malignant transformation of the growth. In such cases, it is recommended to remove the nevus under general anesthesia.

Laser removal of a nevus involves the use of an infrared beam that precisely affects only the area of the neoplasm, without damaging healthy tissue. The surgeon directs the beam to a preset depth, after which he seals the vessels that feed the neoplasm. Laser removal of a nevus is a short procedure and takes about 5-10 minutes, ending with the treatment of the damaged area with an antiseptic solution. The patient can go home almost immediately. [ 3 ], [ 4 ], [ 5 ]

Radio wave removal of nevi involves the use of a so-called "radio knife" that emits high-frequency thermal waves. These waves are directed at pathologically altered tissues, which is how the removal occurs. [ 6 ] The intervention consists of the following stages:

• injection of local anesthetic into the area, preoperative treatment;
• removal of nevus by radioexcision using a working electrode using the Surgitron device;
• antiseptic treatment of damaged tissues.

The incision is made under the influence of heat, which is released by the tissues at the moment of resistance to the penetration of high-frequency waves emanating from a thin wire - a surgical electrode. Under the influence of heat, the cells exposed to the effect disintegrate and evaporate, due to which the tissues move away from each other.

Removal of a nevus with Surgitron takes no more than 10-20 minutes, however this term depends on the size and number of neoplasms being removed.

Removing a nevus with liquid nitrogen is otherwise called cryodestruction. The technique includes the following stages:

• Using special equipment or a mini-applicator, the surgeon applies liquid nitrogen to the growth. The tissue is exposed to a temperature of -195.7°C.
• Under the influence of cold, the pathological element freezes, the cytoplasm in its cells crystallizes, the membranes are damaged. The neoplasm becomes necrotic.
• Over a period of time, the tissues around the removed growth become red and swollen. The formed crust falls off, revealing healthy tissue.

For large spots, one procedure is often not enough. Indications for re-treatment are assessed individually. If necessary, removal of the nevus using a dermatome is supplemented by transplantation of a skin area. [ 7 ]

Nevus removal by electrocoagulation is performed using high-thermal exposure. The procedure is performed using local anesthesia and the so-called "electro-knife", which simultaneously cuts tissue and coagulates vessels. This method is preferably used to remove nevi on a stalk, or elements that protrude strongly above the skin surface. Electrocoagulation can be supplemented with laser resurfacing - a procedure necessary to smooth out wound edges and level the treated area. This ensures an optimal cosmetic effect after healing. [ 8 ]

Removal of moles on the face

Nevus spots on the face are often removed because of their unaesthetic appearance. In addition, other reasons for removal are known:

• when performing daily hygiene procedures, the neoplasm is often injured - for example, during shaving or when applying scrubs or other exfoliating products;
• there is a high risk of malignant transformation.

Nevus growths in the facial area can be removed in various ways, including surgery, radio waves, laser or liquid nitrogen. However, most methods may leave scars on delicate skin. Therefore, specialists often choose the laser method of removal, as it is more gentle and precise. During the procedure, the laser beam penetrates only to the required depth with a given intensity. At the same time, tissue disinfection and coagulation of damaged vessels occur, which has a positive effect on the further process of skin restoration. Removal is usually painless and safe.

Removal of a nevus on the eyelid

Nevi located near the eyes or on the eyelids cause not only visual and mechanical discomfort: they can be easily damaged when removing makeup or during hygiene procedures.

Nevus growths near the eyes are removed in a special way, because the immediate proximity to the organs of vision and thin, sensitive skin play a role.

The removal is performed as accurately, carefully and cautiously as possible, carefully dosing the depth of penetration into the tissue. In addition, it is necessary to remember that there are many small vessels in the eyelid area, and their damage can cause quite severe bleeding.

The most difficult area for intervention is the area above and below the eyelash line. If the nevus is located in this way, it is removed only according to strict indications.

The operation in the eyelid area should be performed only by an experienced specialist who has enough practice to perform such a precise and literally "jewelry" manipulation. The most popular and recommended procedure is the use of a laser.

Removal of pigmented nevi

Dysplastic or pigmented nevi are most often called moles, less often pigment spots. Such formations vary in both size and configuration, ranging from small growths to large diffuse spots.

Pigmented elements can appear on almost any part of the body, including the face. They are recommended for removal as a matter of priority, since they carry the risk of malignant transformation and are often injured.

The method of removing a pigment spot is determined during a medical consultation and diagnosis. The specialist will select and recommend the method that will allow you to remove the growth with minimal discomfort and an optimal recovery period.

If removal of a large dysplastic nevus is planned, the doctor will definitely draw up a special plan for further care and medication.

Removal of intradermal nevus

Intradermal or intradermal nevus is often and widely found in humans. It is usually called a birthmark. It is a dense elastic papule consisting of nevocellular structures localized in the middle (sometimes in the lower) dermal layer.

The average size of such a formation is 10 mm, the most common configuration is hemispherical, color shades range from light brown to almost black.

Light intradermal elements may contain dark inclusions, and sometimes small capillaries become visible on the surface. The growths may be congenital or appear during puberty or later.

The method of removing the neoplasm is determined by a dermatologist or surgeon. It is possible to perform classical surgical excision (for example, if the nevus is large or localized in a hard-to-reach area), electrocoagulation (high-temperature exposure), radiodestruction (hardware procedure "Surgitron", with individual selection of the radio wave length). [ 9 ]

Removal of papillomatous nevus

A papillomatous nevus can be recognized by a bumpy growth that protrudes strongly above the skin surface and resembles a papilloma in appearance. It can be both congenital and acquired. This element is extremely prone to damage and also causes considerable psychological discomfort to its owner. Therefore, despite the slight tendency of the growth to become malignant, it is still recommended to remove it.

The formation can be eliminated by laser surgery, cryodestruction, radio wave method, electrocoagulation, or by surgical excision. Any of the listed procedures is performed using local anesthesia.

The most optimal cosmetic effect is achieved with laser removal of the nevus. But this method is not prescribed if we are talking about small spots with questionable diagnostics, requiring subsequent histological examination of the tissues. [ 10 ]

Removal of blue nevus

A blue nevus is an acquired, protruding formation above the skin surface, usually hemispherical, smooth, bluish-blue (less often - brownish) shade, without hair growth. It is often localized in the face, on the arms and legs, buttocks. In its development, the growth goes through the stages of fibrosis and proliferation of melanocytes. If fibrosis predominates, then they talk about regression of the neoplasm.

You should think about removing such a growth if it begins to rapidly increase or peel. The danger of malignant transformation is indicated by the heterogeneity of the color shade, the appearance of additional inclusions and nodules inside the element.

One of the most common methods of removing the blue spot is laser surgery: due to the precise selection of the depth and frequency of the pulse action, only the nevus tissue is removed during the procedure. Healthy tissue is not damaged.

Removal of a large nevus

Removal of a giant nevus is performed according to the following indications:

• to improve a person's appearance;
• to reduce the likelihood of malignant transformation of the tumor.

If possible, a large spot is removed, the sooner the better. In case of congenital pathology, the earliest possible operation is performed, especially if the problem area is located on the face or in places subject to regular damage or friction. Difficulties with removal may arise if the nevus is localized near vital organs or structures.

Often the size of the affected area is so large that it requires gradual, staged removal. In many cases, the use of a tissue expander and graft is required to correct the consequences of the intervention.

It is important to understand that patients with giant melanocytic lesions have an increased risk of developing aggressive melanoma, a malignant process that develops from melanocytes. This risk is estimated at approximately 5-10%. If degeneration occurs, the prognosis in this situation is unfavorable, and survival is extremely low. In addition, there is a risk of developing other oncoplasms, such as sarcoma, lipoma, and tumors of the nervous system. To avoid such complications, melanocytic nevus should be removed in advance.

Removal of conjunctival nevus

Conjunctival nevi may be represented by pigmented or non-pigmented elements, localized in any area of the bulbar conjunctiva, or, much less frequently, on the conjunctiva of the eyelids.

Treatment of such a neoplasm can be different: both expectant tactics and radical removal are used. Among the most popular surgical techniques are excision, [ 11 ] electroexcision, cryodestruction. Modern treatment involves radical removal of the spot with the achievement of a functional outcome with an optimal cosmetic effect.

One of the most common surgical methods today is radio wave removal, which allows for the separation and removal of pathological tissues with simultaneous coagulation of damaged structures. The use of nitric oxide at the postoperative stage helps to accelerate the epithelialization processes and improve the cosmetic effect.

Removal of border nevus

A borderline nevus resembles a dysplastic neoplasm, but, unlike it, it has a regular shape - round or oval, and a uniform color. The neoplasm is located in the border, basal epidermal layer. In most cases, the growth looks slightly raised above the skin surface, it is smooth and shiny, without hair growth. Color shades - from light brown to dark (almost black). It can be found on the arms and legs, the body, often located in the form of several spots.

Possible treatment options for borderline nevus:

• Cryodestruction. [ 12 ]
• Electrocoagulation. [ 13 ]
• Laser thermocoagulation. [ 14 ]
• UHF coagulation. [ 15 ]
• Surgical excision.

Progressive borderline growths require excision, both for prevention and for early diagnosis of cutaneous melanoma. If a malignant process is detected, a repeated intervention is performed with excision of the postoperative scar, but the need for such an operation is decided individually.

Removal of warty nevus

A verrucous nevus looks like a wart. It has an uneven surface, permeated with many "wrinkles" or small cracks. Two therapeutic approaches are used in relation to such nevi: observation and removal. Removal is considered if the following signs are present:

• excessively bright color shade or change in color;
• structural unevenness or uneven growth;
• the appearance of pain, itching, bleeding;
• an awkward position that causes discomfort and/or contributes to regular injury.

The recommended method of removing a nevus is surgical, which involves excision of the growth along with the subcutaneous fat. The obtained biological material is sent for histological diagnostics to ensure the absence of malignancy. If surgical intervention is contraindicated, other methods of eliminating the problematic element are used. [ 16 ]

Verrucous epidermal nevus is successfully treated with photodynamic therapy. [ 17 ], [ 18 ]

Removal of congenital nevus

The specifics of patient management with a congenital nevus formation are determined by the doctor individually. The size of the spot plays a special role in the choice of tactics.

• If the size of the growth does not exceed 1.5 mm, then it is recommended to routinely monitor the patient until he or she reaches 18 years of age, since the risk of early degeneration of such a neoplasm is less than 1%.
• If the size of the growth is within 1.5-10 mm, then it is either observed or removed, at the discretion of the specialist. When choosing tactics, they are guided by the presence or absence of somatic pathologies, features of the skin, and the aesthetic side of the issue.
• In case of large or giant nevus sizes (10-20 mm and more) the risks of malignancy are especially high. In this regard, it is recommended to remove such a formation, and observation is established only if it is impossible to perform an intervention. [ 19 ]

Removal of nevus from a child

Nevi are equally common in both adults and children. And in many cases, single formations are present in children from birth, although they can appear a little later - after several months. Whether to remove or not touch the spot is decided by a pediatric dermatologist, after conducting a comprehensive diagnosis. It is important to note that before the child reaches 18 years of age, nevi are removed only according to strict indications. [ 20 ]

Conventional surgical excision is a reliable method of removing a nevus, but it is used mainly for large neoplasms. In addition to surgical intervention, electrocoagulation, radio wave or laser exposure can be used in childhood. [ 21 ]

Removal of a nevus in childhood must be carried out in a special clinic or surgical (dermatological, oncological) department, where there is appropriate diagnostic and therapeutic equipment, instruments, anesthetics. Beauty salons are not suitable for this purpose. It is strictly forbidden to remove nevi in children on your own.

Recommendations for parents of children with pathological nevus formations are as follows:

• In the presence of congenital nevi, it is important to regularly consult a dermatologist or oncologist. Such observation should continue until the patient reaches 20 years of age (unless there are indications for removing the pathological spot).
• Medium-sized growths, in the absence of contraindications, can be removed at the age of 7-12 years.
• If it is necessary to remove a large or giant nevus, it is recommended to additionally consult a plastic surgeon.
• Measures should be taken to avoid injury to nevi and avoid exposing them to ultraviolet light.

Histology after nevus removal

Histological examination is most often performed after complete removal of the nevus; less often, only a small sample of biomaterial is taken for diagnosis.

The tissues being examined are placed in a special suspension and examined under a powerful microscope. The specialist identifies or excludes dangerous cellular structures, draws up a conclusion, on the basis of which a diagnosis is subsequently made.

The advantage of this method is that histology can detect malignant cells at the earliest stage of their development. Such information allows the doctor to prescribe the correct treatment, eliminating further development of adverse effects.

Not all nevi require histology. It is necessary to perform this study:

• if there are ulcers or cracks on the surface of the nevi;
• if all the hairs from the neoplasm suddenly disappear;
• if there are unpleasant sensations, itching, burning, pain in the area of the nevus;
• if the skin around the nevus spot becomes red and swollen;
• if the size, shape, color shade, or structure of the growth has changed.

At the slightest suspicion of malignancy of the neoplasm, it should be removed, and the obtained biomaterial should be sent for further histological examination. In some cases, diagnostics are carried out before the nevus is removed, in order to define the boundaries of the operation and draw up a further treatment and recovery plan.

Contraindications to the procedure

In general, there are no absolute contraindications to nevus removal. However, there are a number of relative contraindications, in the presence of which only the doctor decides whether to perform the operation or not. We are talking about the following diseases and conditions:

• malignant processes, regardless of their location;
• viral hepatitis, HIV, diabetes;
• the period of pregnancy and breastfeeding;
• relapses of chronic pathologies;
• infectious and inflammatory pathologies;
• mental disorders;
• decompensated conditions, severe pathologies of the cardiovascular and respiratory systems;
• disorders of the blood coagulation system;
• increased skin sensitivity to light;
• autoimmune pathologies;
• dermatological diseases in the area of the proposed intervention;
• active herpes.

If a patient is found to have a suspicious nevus with an increased probability of malignancy, then there are practically no contraindications to its removal.

Complications after the procedure

Some possible complications include:

• Redness of the skin in the area of the removed nevus may be present throughout the healing period, which is considered normal. However, if swelling and pain join the redness, you should definitely seek medical help: signs of inflammation indicate the development of an infectious and inflammatory process in the wound.
• The pain is most often present for several days after the procedure, and gradually disappears as the tissues heal. If complications develop in the form of an inflammatory reaction, the pain intensifies, becomes pulsating, and is accompanied by swelling and hyperemia.
• A pit or depression on the skin appears if the removed nevus was located deep in the tissues: the defect becomes noticeable after the crust falls off. Smoothing of the depression still occurs gradually, but this process can last quite a long time - from six months to 2 years, or even more.
• The temperature after nevus removal may increase slightly for 24 hours, after which it returns to normal. This effect is associated with the body's reaction to tissue integrity damage and general stress. If the temperature does not stabilize after 48 hours, and signs of inflammation appear in the wound area, you should immediately consult a doctor.
• The discharge of pus from the wound indicates the penetration of a purulent infection, which could have occurred both during the intervention and due to improper care of the wound surface. A doctor should treat the purulent process.
• Changes in skin pigmentation in the damaged area are often temporary and correct themselves over the course of several months.

Consequences after the procedure

Adverse effects may occur due to improper or insufficient postoperative care of the wound surface. Most often, problems are caused by infection getting into the wound, tearing off the formed crust. It should not be forgotten that the suture after removing the nevus must be treated with disinfectant solutions, and after the scab falls off, healing and absorbable ointments should be used to prevent the formation of a rough scar.

If the intervention was performed using laser technology, and the size of the neoplasm was small, then after healing there will be practically no visible traces on the skin. A scar after nevus removal almost always remains if surgical excision was used, as well as in cases of improper wound care. For example, forcible tearing off of the crust necessarily leads to further formation of an unsightly and even rough scar.

To improve the appearance of the damaged area and prevent scar formation during the healing stage, special absorbable external preparations should be used - for example, Contractubex ointment, Kontrarubec, Solcoseryl, etc.

Nevus recurrence after removal

In general, the recurrence rate of excised nevi is low, one prospective study found only 3.4% recurrence [ 22 ], [ 23 ] and necessitates repeated surgery, sometimes multiple times, unless radical surgical excision is used. Recurrent nevus is defined as a separate nosological entity, which indicates the existing differential diagnostic difficulties in this matter.

Recurrent growth of the neoplasm most often occurs within six months after removal of the primary element. If the nevus was removed layer by layer to the subcutaneous tissue, then recurrence was observed only in isolated cases. [ 24 ]

The probability of recurrence is determined by the following clinical and epidemiological risk factors:

• gender (women experience relapses more often);
• age (usually at a young age);
• anatomical location (relapses occur more often after removal of nevi in the back and upper limbs);
• removal period (mainly within six months after surgery).

The recommended method for removing a recurrent nevus is surgical excision followed by histological examination.

Can removing a nevus cause melanoma?

Complete and one-time removal of a nevus cannot give impetus to the development of a malignant process. However, melanoma can be provoked by conducting a partial biopsy, so it is not recommended to perform it in such a volume: if necessary, only superficial smears are taken for histological examination, provided that there are damages, cracks or erosions on the neoplasm.

Malignant transformation also occurs after partial excision of nevus elements, so such intervention is usually not practiced. The spot or growth is removed completely, and only then the biomaterial is sent for histological examination. In this case, the risk of malignancy is practically absent.

Care after the procedure

The main condition for fast and high-quality tissue regeneration after nevus removal is compliance with all medical recommendations. The following rules should be followed for 10-14 days after the procedure:

• do not touch or remove the crust that has formed on the wound;
• treat the removal area with medications prescribed by the doctor;
• after the crust has come off on its own, use special healing and absorbent ointments;
• do not wet the wound until the crust comes off;
• do not apply cosmetics to the operated area;
• do not expose the area with the removed nevus to ultraviolet rays, do not sunbathe or visit a solarium;
• Do not drink alcohol (to avoid causing bleeding due to vasodilation).

If everything is done correctly, the risk of unpleasant consequences is reduced to zero.

How to treat a wound after removing a nevus?

After the nevus removal procedure, the wound is treated twice a day, in the morning and in the evening. For treatment, use a pink solution of potassium permanganate or the pharmacy drug Fukortsin. You can sprinkle the wound surface with Baneocin. After a few days, at the discretion of the doctor, prescribe external drugs with a restorative effect, such as Bepanten, Solcoseryl, Emalan, as well as methyluracil ointment.

For 5-10 days, you should not wet the wound and especially not tear off the crust that has formed. If water does get on the wound, it should be dried with an alcohol solution: calendula or propolis tincture will do, and even a regular brilliant green solution.

After the scab comes off on its own and pink "young" skin is exposed, you can lubricate the surface with restorative preparations - for example, Contractubex, Bruise-off, Rescuer, etc. Ointments are applied 2-4 times a day. The duration of treatment can be from 3-4 weeks to several months.

In the future, to avoid changes in pigmentation, the damaged area is regularly lubricated with sunscreens with an SPF factor of 15-30, and during periods of increased solar activity - with SPF 50.

The duration of healing and complete recovery after nevus removal is individual. This term usually varies from 2-3 weeks to 1.5-2 months. Healing takes a little longer in elderly patients, diabetics and people with weakened immunity.