Seborrheic Keratoses and Skin Tags: Laser Removal

Seborrheic keratoses and skin tags are common, harmless skin growths that many people choose to remove because they catch on clothing, become irritated or simply bother them. An Er:YAG laser can remove them by vaporising the growth in very thin layers, usually leaving a small pink mark that fades over weeks. Before any removal, though, the spot needs to be confidently identified as benign, because some skin cancers can look similar.

What these growths are

Seborrheic keratoses are raised, rough or waxy spots that can be tan, brown or almost black. They often look "stuck on," like a drop of candle wax or a crumb of dark clay, and may have a warty or slightly greasy surface. They become more common from middle age onward, tend to run in families and can appear in large numbers on the back, chest, face and scalp. They are not caused by viruses and are not contagious.

Skin tags (acrochordons) are small, soft flaps of skin attached by a narrow stalk. They are usually skin-coloured or slightly darker and appear where skin rubs: the neck, underarms, eyelids, groin and under the breasts. They are more common with age, weight gain, pregnancy and conditions such as diabetes or insulin resistance. If you develop many skin tags quickly, it is worth mentioning to your family doctor.

Neither type turns into cancer. Removal is optional and usually cosmetic, unless a growth is repeatedly irritated, bleeding or catching on jewellery.

Why diagnosis comes first

Laser removal destroys the tissue, so nothing is left to examine under a microscope afterwards. That is why a spot should only be treated when a physician is confident it is benign. Melanoma, basal cell carcinoma and other skin cancers can occasionally resemble a seborrheic keratosis, especially a dark or irregular one.

Signs that a spot needs a doctor's assessment, and possibly a biopsy, before any cosmetic treatment include:

• a new spot that looks different from your others
• changes in size, shape or colour, or more than one colour
• bleeding, crusting or a sore that does not heal
• itching or pain without an obvious reason
• a growth that appeared suddenly along with many others

Your family doctor or a dermatologist can examine any spot you are unsure about. Our guide on checking moles and when to worry covers the warning signs in more detail.

How Er:YAG laser removes them

The Er:YAG wavelength is strongly absorbed by water in skin, which allows the clinician to remove tissue in extremely thin, controlled layers with little heat spreading to the surrounding skin. The laser is passed over the growth until it is level with the surrounding skin. A small skin tag may be treated at its stalk.

A numbing cream or small injection of local anaesthetic may be used. Several growths can often be treated in one visit, depending on size and location. Most flat or slightly raised spots need a single treatment, though thicker growths may need a touch-up.

Other ways to remove these growths include freezing with liquid nitrogen, scraping (curettage) and snipping skin tags. Each has trade-offs in healing and pigment risk, and the most suitable method depends on the size, location and your skin type.

Planning around location and timing

Where a growth sits makes a difference. Spots on the face tend to heal quickly, while those on the legs and lower body heal more slowly. Growths under a bra strap, waistband or collar may be rubbed during healing, so it can help to plan clothing in advance. Because sun on new skin raises the chance of darkening, many people prefer to treat visible areas in fall or winter. If you have many growths, treating a few at a first visit lets you see how your skin heals before doing more.

Healing and aftercare

After treatment, the area is usually a shallow, pink or raw spot that may weep slightly for the first day or two, then forms a thin crust. Healing generally takes one to two weeks, longer on the legs and body than on the face.

• Keep the area clean and covered with a thin layer of petroleum jelly or the ointment your clinician suggests.
• Do not pick at the crust; let it come off on its own.
• Protect healed areas from sun, as new skin is prone to darkening.
• Contact the clinic if you see spreading redness, increasing pain, pus or fever.

Pinkness may remain for several weeks and gradually fades. New seborrheic keratoses and skin tags can continue to appear over time, since the tendency to form them remains.

Who should not have removal, or should wait

• any growth that has not been confidently diagnosed as benign
• during pregnancy, unless a growth is causing a real problem and your physician agrees
• with infection or inflammation in the area
• with a recent tan, which increases pigment risk
• with a history of keloid scarring, especially on the chest and shoulders
• with poorly controlled diabetes or conditions that slow healing, until discussed

Mention any blood thinners or supplements, but do not stop a prescribed medicine on your own.

Main risks

The most common lasting change is in pigment: the treated spot may heal slightly darker or lighter than surrounding skin, especially in medium to darker skin tones. Darkening often fades over months; lightening may be longer-lasting. Other risks include infection, a small scar or textured spot, and incomplete removal needing another session.

Frequently asked questions

Will removing one cause more to grow?

No. New ones may appear over time, but this reflects your skin's tendency, not the treatment.

Is removal covered by MSI?

Cosmetic removal of benign growths is generally not covered. Your family doctor can advise if a lesion needs medical removal.

Can skin tags on the eyelids be treated?

Sometimes, with eye protection and careful technique. Some eyelid growths are better referred to an eye specialist.

If seborrheic keratoses or skin tags bother you, HealthPark Medical Aesthetics can examine them, recommend medical assessment for anything uncertain, and explain whether laser or another method suits your skin. For related spots, see laser for sun spots.