Non-surgical removal of skin lesions

Non-surgical removal of skin lesions is a group of methods that allow benign skin lesions to be removed without a scalpel and without stitches. At the Dr Kuschill MEDESTETIS Clinics we primarily use cryosurgery, i.e. freezing the lesion with liquid nitrogen, as well as curettage – the mechanical removal of the lesion with a special curette.

In addition to cryosurgery and curettage, we use energy-based methods: plasma and the CO₂ laser. In both, an energy beam vaporizes the lesion tissue layer by layer without affecting the surrounding area. Thanks to this precision, they are especially well suited to small lesions in areas requiring accuracy — for example on the eyelids, around the eyes, or on the face — and bleeding during the procedure is minimal.

These methods are effective for removing benign lesions such as viral warts, soft fibromas, seborrheic warts, or xanthelasma. The procedure is quick, minimally invasive, and usually requires no anesthesia or only local anesthesia is sufficient.

Every procedure is preceded by a medical qualification and assessment of the lesion, using a dermatoscope if needed. This is a key stage – safe, non-surgical removal of warts and other lesions is only possible when the lesion is benign in nature. Lesions that raise concerns are referred for surgical excision with histopathological examination.

You may consider non-surgical removal of skin lesions in cases such as:

• viral warts (verrucae), including plantar and palmar warts
• soft fibromas (so-called skin tags)
• seborrheic warts
• xanthelasma of the eyelids
• milia and small epidermal lesions
• other benign lesions removed for aesthetic reasons or because of irritation

The choice of method and whether it can be applied is decided by the physician after assessing the nature, size, and location of the lesion.

The procedure begins with a consultation and assessment of the lesion. The physician examines it, performs a dermatoscopic examination if needed, and qualifies it for a non-surgical method or – if the lesion raises concerns – refers it for surgical excision with histopathological verification.

In cryosurgery, the physician applies liquid nitrogen to the lesion, causing its controlled freezing and tissue death. The procedure usually takes a few to several minutes. In curettage, the lesion is removed mechanically with a special curette, often after local anesthesia. Neither method involves stitches. Larger or resistant lesions, such as viral warts, may require several sessions at intervals of a few weeks.

The plasma or CO₂ laser procedure is performed under local anesthesia. The device vaporizes the lesion spot by spot, and a small scab forms at the treatment site, which falls off on its own within a few to several days. As with the other methods, no stitches are used.

The result is removal of the lesion and smoothing of the skin surface. After cryosurgery, a blister or scab forms at the treatment site, which falls off on its own within several days, revealing new, healthy skin.

The removed lesion does not grow back, although non-surgical methods do not protect against new lesions appearing elsewhere – particularly viral warts of an infectious nature. You assess the final cosmetic result once the skin has fully healed.

Proper care of the treated site speeds up healing and reduces the risk of discoloration. Remember to:

• not pick off the scab or pierce any blister that forms
• keep the treatment site clean and dry
• use the disinfecting or healing preparations recommended by the physician
• protect the area from the sun and use a high-SPF sunscreen to prevent discoloration
• avoid the swimming pool, sauna, and long hot baths until healed
• come in for a follow-up or the next session on the date arranged with the physician

Contraindications and situations requiring caution include:

• a lesion with features suspicious for cancer (absolutely requires excision and histopathological examination, not cryosurgery)
• an unclear or uncertain nature of the lesion
• an active skin infection at the treatment site
• clotting disorders or taking anticoagulants (requires assessment)
• poorly controlled diabetes and impaired healing
• a tendency to form keloids and discoloration (relative contraindication)
• pregnancy and breastfeeding (requires individual assessment)

The final qualification is carried out by the dermatologist during the consultation.