What methods are used to remove a skin tag in a clinic?

Skin Tag Removal in the Clinic

Snip excision with scissors after ethyl chloride spray anesthesia is the most effective and painless method for removing skin tags in the clinic setting. 1

Primary Removal Technique: Snip Excision

The preferred approach is simple scissor excision using micro-scissors and micro-forceps after topical anesthesia with ethyl chloride spray. 1 This method provides:

• Immediate removal in a single visit with minimal patient discomfort 1
• No need for injectable local anesthesia, which itself causes pain when treating multiple lesions 1
• Superior patient satisfaction compared to conventional techniques requiring infiltrative anesthesia 1

Procedure Steps:

• Apply ethyl chloride spray to the skin tag for topical anesthesia 1
• Grasp the pedunculated lesion with micro-forceps 1
• Cut the pedicle at the base with micro-scissors in a single motion 1
• Apply hemostasis if needed (typically minimal bleeding occurs) 1

Alternative Removal Methods

Cryotherapy

Cryotherapy with liquid nitrogen is an effective alternative for benign lesions like skin tags. 2 This method:

• Uses dipstick or spray techniques to freeze the lesion 2
• Requires no injectable anesthetic 2
• Provides good cosmetic results with high cure rates 2
• May cause blistering, edema, and temporary pain as expected side effects 2

Common pitfall: Cryotherapy requires multiple freeze-thaw cycles and the lesion falls off over days to weeks, unlike immediate removal with excision 2

Electrodesiccation

Electrodesiccation can destroy skin tags through thermal coagulation 3, though this requires more equipment and may cause more discomfort than simple excision 1

Mechanical Occlusion Device

A flat adhesive patch device that applies pressure to occlude blood flow can remove skin tags over 3-6 days 4:

• 90% success rate for lesions up to 1mm at the base 4
• 76% success rate for lesions up to 2mm at the base 4
• Minimal discomfort throughout treatment 4
• Excellent cosmetic outcome 4

This method is best suited for patients who prefer non-invasive removal and can tolerate the 3-6 day treatment period. 4

Special Considerations

Location-Specific Approach

For anal skin tags specifically, removal during other procedures can be simplified by using specialized equipment 5. However, in patients with Crohn's disease, excision of perianal skin tags is contraindicated due to high rates of poor wound healing and subsequent complications including proctectomy. 6

Lesion Size Considerations

• Pedunculated lesions are ideal candidates for snip excision 1, 3
• Smaller lesions (≤2mm base) respond better to all treatment modalities 4
• Multiple widespread lesions are best treated with ethyl chloride spray technique to avoid multiple painful injections 1

Key Clinical Pearls

Avoid infiltrative local anesthesia for routine skin tag removal - it causes unnecessary pain when treating multiple lesions and ethyl chloride spray provides adequate anesthesia 1

Skin tags commonly occur in intertriginous areas (neck, axilla, groin) and may be friction-induced 3, so counsel patients about potential recurrence in these areas

The cosmetic outcome is excellent with proper technique regardless of method chosen 4, 2