Skin Tag Removal: Scissors vs Shave Technique
For routine skin tag removal in adults, scissor excision (snip excision) is the preferred technique, as it is fast, effective, and can be performed with minimal anesthesia such as ethyl chloride spray, making it more comfortable than shave techniques that typically require infiltrative local anesthesia. 1
Recommended Technique: Scissor Excision
Scissor excision with micro-scissors and micro-forceps is the optimal approach for most skin tags, particularly when combined with ethyl chloride spray anesthesia rather than infiltrative local anesthesia. 1 This method offers several advantages:
- Pain control: Ethyl chloride spray provides adequate anesthesia for pedunculated lesions without the discomfort of needle infiltration 1
- Speed and efficiency: The pedicle can be cut with a single movement, making it ideal for multiple lesions 1
- Patient satisfaction: Patients who previously underwent conventional techniques with infiltrative anesthesia report the ethyl chloride/scissor method as significantly more comfortable and painless 1
Technical Execution
- Grasp the skin tag at its base with micro-forceps to stabilize the lesion 1
- Apply ethyl chloride spray directly to the base for topical anesthesia 1
- Cut the pedicle cleanly at the base with micro-scissors in a single motion 1
- Ensure complete removal at the base to prevent recurrence 1
Alternative Methods (Less Preferred for Routine Cases)
While other techniques exist, they have specific limitations:
- Cryotherapy: Effective but may require multiple treatments 2
- Electrodesiccation: Requires more equipment and may cause more discomfort 2
- Mechanical ligation devices: Show 90% success for lesions ≤1mm base diameter, but only 65% overall success rate, with outcomes declining significantly for larger lesions (76% for ≤2mm base) 3
Critical Contraindications
Never excise perianal skin tags in patients with Crohn's disease. 4, 5, 6 This is a strong recommendation from multiple gastroenterology societies:
- High complication rates: Poor wound healing, chronic non-healing ulcers, and extensive scarring are common 4, 6
- Severe outcomes: May necessitate subsequent proctectomy 4, 5, 6
- Management approach: Observation is strongly preferred over any surgical intervention in this population 4
Post-Procedure Care
- Minimal bleeding at the excision site is expected and typically self-limited 1
- Simple wound care: Keep area clean and dry; gentle soap and water cleansing is acceptable 5
- Monitor for infection: Expanding erythema >5cm, purulent discharge, or fever >38.5°C warrant evaluation 5
- Avoid empiric antibiotics: Do not start antibiotics without clear signs of infection, as serous drainage is normal 5