Lumps & Bumps

Ultrapulse CO2 laser

CO2 laser is strongly absorbed by water in cells. Laser energy vaporizes a layer of skin cells together with a surrounding zone of coagulation. Ultrapulse CO2 produces very short pulses of laser energy with high peak power. The amount of tissue vaporisation vs coagulation can be tailored, allowing for precise vaporisation of only the abnormal tissue without causing too much collateral damage.

Radiofrequency ablation

High-frequency radiofrequency is strongly absorbed by water in cells causing vaporization or coagulation depending on the waveform. It can be used to dissect out lumps or coagulate them. Insulated needles can also be used to treat deeper lumps such as syringomata or sebaceous hyperplasia while sparing the skin surface, reducing the downtime and chance of scarring.

Surgical excision

Lumps that extend through most of the dermis or that need to be sent to the laboratory to be examined under the microscope should be surgically excised. Cold steel, ultrapulse CO2 or high-frequency radiofrequency are used to dissect out the lump. The direction and position of the incision are designed to camouflage the scar. The resultant wound is closed with a tension-free layered technique using absorbable and non-absorbable sutures according to plastic surgical principles to produce an aesthetically pleasing result.

Most skin lumps are benign. Benign lumps that are on the surface or not too deep in the skin can be vaporized. Dr Wan uses ultrapulse CO2 and high-frequency radiofrequency that can provide tunable amounts of ablation and coagulation to vaporize precisely only the lump. It is important to have fine control over the destruction of abnormal tissue without causing too much collateral damage that can lead to complications such as scarring or post-inflammatory hyperpigmentation.

Not all lumps should be vaporized.

• Any skin growth that looks or sounds suspicious for cancer should be excised and sent for examination to rule out cancer.
• Bigger, deeper growths that occupy much of the dermis may result in depressed scarring if vaporized. Excision may produce a better overall result.
• Lumps that are buried deep with a thick intervening layer of skin should be coagulated using radiofrequency via insulated needles to reduce the chance of depressed scarring.

Topical medication, as well as sun damage protection, should be adhered to reduce the risk of complications.

After the skin surface has healed, early prophylactic fractional laser should be instituted to blend the treated area with the surrounding skin and make the final result much more inconspicuous.

Dr Wan Chee Kwang

FOUNDER / MEDICAL DIRECTOR

To Dr Wan, the most important factors are how to remove the lump safely and completely with the best aesthetic outcome. Hence, pre-procedural analysis and planning is important, as is a wide variety of precise methods to remove the lump together with fine judgement as to how much tissue to remove. Lastly, the wound closure technique is very critical for the final result. Dr Wan’s previous surgical training during plastic surgery rotations has equipped him with exposure to various plastic surgical techniques such as V-Y plasty, M-plasty, geometric closure, etc that allows him to advise patients on the most suitable method to use.