Skin blemishes may be flat or raised, scaly or oily, inflamed or quiescent, almost any colour, and can have a huge variety of causes. Many skin marks are entirely benign, and only require removal for aesthetic reasons or because they are itchy, are rubbed by clothes or hinder activity. Some are malignant or show signs of becoming malignant and should be removed and sent for a specialist examination of the cells (histology), including the margins of the excision sample, to check that all the remaining tissues are healthy.
Recent advances in laser and light devices have added to the armamentarium for treatment of skin blemishes and lesions. There are a great many types of laser and light device and with intelligent use, these are very safe. Verrucae and warts which have failed to respond to conventional laser treatment are often very effectively treated with the carbon dioxide laser. Depilation laser treatment can heal a pilonidal sinus which has survived many conventional surgical attempts at healing it.
Red blemishes such as thread veins. port wine stains and spider naevi are caused by blood vessels beneath the skin, and vascular laser treatment may be helpful. Red scarring may also be helped by laser treatment but despite claims to the contrary, there is little to be done for stretch marks themselves once the redness has faded, although general tightening of the skin can be useful.
For some marks the best treatment is laser therapy alone, and for others, particularly some cancers, a combination of conventional excisional surgery and laser treatment can reduce scarring whilst still ensuring safe removal of malignant cells.
The majority of skin blemishes can be treated under local anaesthetic in an out-patient (minor ops) theatres.