Surgical Dermatology

mole removal in olympia


Moles and birthmarks are benign pigmented spots or patches of skin that range in color from tan, brown and black (moles) to red, pink, or purple (vascular lesions, such as strawberry hemangiomas or port wine stains).  Moles exhibiting any of the following warning signs should be examined by a board-certified dermatologist immediately:

  • Larger than six millimeters
  • Symptomatic (ie., itches or bleeds)
  • Rapidly changing in color, size or shape
  • Has multiple colors
  • Located in area that can’t be easily monitored, such as the scalp

Depending on their depth, location and color, as well as the patient’s skin type, age and other factors, treatment for benign but unattractive birthmarks may take the form of laser or pulsed light therapy, surgical excision, or shave removal.


Skin tags, or acrochordons, are very common small, soft skin growths that occur on the eyelids, neck, armpits, groin folds, and under breasts.  They are harmless but annoying.  Skin tags usually occur at middle age and can be associated with obesity.  They typically result from friction due to jewelry or clothing rubbing against the skin.  Removing a skin tag does not cause more to grow.  It is recommended that they be removed if they become irritated or a cosmetic nuisance.  Depending on size and location, skin tags can be removed with cryotherapy or snipped off.


A skin biopsy is a diagnostic test that involves removing a tissue sample and examining it under a microscope.  This test is used to identify suspicious lesions and to differentiate normal cells from abnormal ones.

Reasons for Skin Lesion Biopsies

Skin lesion biopsies are performed when simple visual examination by the physician is insufficient to make a clear cut diagnosis.  Such biopsies are done in order to make a definitive diagnosis of:

  • Skin infections which may be fungal, bacterial or viral
  • Skin growths like moles, warts, or seborrheic keratosis
  • Precancerous lesions like actinic keratosis
  • Bullous pemphigoid and other blistering skin disorders
  • Dermatitis, such as eczema or psoriasis
  • Skin cancers, including basal cell, squamous cell, and melanoma

The Skin Lesion Biopsy Procedure

Since a local anesthetic will be administered prior to the biopsy, the procedure will not be painful.  Depending on depth of involvement, Dr. Jessica Kim will determine if a superficial shave biopsy or a deeper punch biopsy is required.  Following the biopsy, the tissue sample is stored in a preservative solution or a sterile container until it can be processed at a pathology laboratory.  Once the specimen has been prepared and thoroughly examined under a microscope, a diagnosis will be made to determine what the course of follow-up treatment, if any, should be.

Results and Further Treatment After Skin Lesion Biopsy

It may take several days to 2 weeks to receive laboratory results, depending on the type of biopsy that has been performed and on the types of testing required.  Depending on what the laboratory results show, medication may be prescribed, further excision may be necessary, or, in the case of serious malignancy, radiation or chemotherapy may be required.  In many cases, where the biopsy shows no abnormality, there will be no further treatment necessary.



Cryotherapy refers to treatment of surface skin lesions with liquid nitrogen.  Lesions that may be treated with cryotherapy include the following:

  • Actinic keratosis
  • Viral warts
  • Seborrheic keratosis

Freezing may be the most suitable way of getting rid of many different kinds of surface skin lesions.  It is relatively inexpensive, safe, and reliable.  However, it is important that the skin lesion has been properly diagnosed by a board-certified dermatologist prior to treatment.

The treated area is likely to blister within a few hours.  Sometimes the blister is clear and sometimes it is red or purple due to bleeding (this is harmless).  Usually no special attention is needed during the healing phase.  The treated area may be gently washed once or twice daily, and should be kept clean and petroleum jelly applied to speed healing.



Modern, high-frequency electrosurgical devices transfer electrical energy to human tissue via a treatment electrode that remains cool.  Electrosurgery is used to destroy benign and malignant skin lesions, to control bleeding, and to cut or excise tissue.  Electrosurgery is simple to perform and is useful for treating a variety of skin lesions, especially small superficial lesions (ie., skin tags, seborrheic keratosis, small angiomas).  Electrodessication is one major modality in electrosurgery.  An active electrode touches or is inserted into the skin to produce tissue destruction.  Resulting superficial wounds heal quickly by secondary intention.  To speed healing, wounds are cleansed daily and then covered with petrolatum or antibiotic ointment.  It is important that skin lesions be properly diagnosed by a board-certified dermatologist prior to treatment.


The auricle (outside) of the ear is composed entirely of soft tissue.  The more rigid areas consist of only skin covering cartilage with a minor amount of connective tissue between the two, while the ear lobe itself is just a fatty tissue deposit at the bottom of the auricle.  These are fragile structures that are very susceptible to damage, especially after being pierced; large and heavy pieces of jewelry will only exacerbate the weakness of the ear lobe.  Luckily, because there is no cartilage in the actual ear lobes, they can generally be repaired with successful results and minimal risk of deformity.

If a person’s ear lobe does split, whether from jewelry being aggressively pulled or through chronic use of heavy weighted jewelry, the procedure is quite simple.  Local anesthetic is applied through injection into the ear lobe and the two ends of the tear are brought together by both dissolving sutures in the inner tissue and skin sutures on the surface.  The wound is given some ointment as a dressing as is expected to drain itself as it heals.

Ear lobe reconstruction patients generally do not need pain medication, as over-the-counter pain relievers will suffice if discomfort persists.  The ear should be washed daily for a week after surgery, but no piercings or jewelry may be used for two to six months after surgery.  Skin sutures, if used, will be removed one to two weeks after surgery.  Otherwise, recovery is quite fast, with most patients returning to normal activity in less than a week.

As with all surgical procedures, risks of infection and scarring do exist.  These risks can be controlled by conscientious and diligent care by both patient and doctor.


contactIf you have any questions or comments, or if you want to learn more about the services we provide, please call us at 360.918.8101 . For a consultation, or to setup an appointment click here.

Cosmetic Dermatologist Serving Olympia, Lacey, Tumwater, Tacoma, Puyallup, Gig Harbor, Centralia, Shelton, Federal Way & surrounding areas in Washington.

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