Papilloma and fibroma removal is one of the most common skin interventions.
They can be removed surgically, using radiofrequency, with liquid nitrogen or by excision. Patients frequently ask whether papilloma removal is necessary and whether new ones will appear if they are not removed regularly. Very rarely papilloma can resolve spontaneously, and more often small interventions are needed.
What are papillomas?
Skin papillomas are soft benign growths on a stalk (peduncle), of same colour as skin, painless, different in size and quantity. They are completely benign, do not spread and are not aggressive.
How papillomas are formed
We do not know why papillomas occur. They are believed to be the result of irritating skin rubbing, skin indentation and circulation disorder.
For years, there has been a discussion over whether the HPV virus is involved in skin tags (or soft fibroma) formation. This has never been clearly proven when it comes to the skin. There are many more scientific reports related to the mucous membrane.
The triggers for their formation are known to be:
Metabolic disorders with increased level of cholesterol and triglycerides
Increase in female hormones, pregnancy
Where do papillomas appear
Predilection sites for skin papillomas are folds of the skin, where the skin rubs together. Almost every person will develop a soft fibroma on the neck, armpits, eyelids or groin during their lifetime.
They are more common in people over the age of 40, both men and women. Nowadays, they can also be seen in younger people, teenagers. It is believed that this is a consequence of the increased obesity and diabetes in children. Papillomas that form on the skin are also called fibromas. They cannot become malignant over time, that is, they cannot develop complications due to cell growth. Papillomas can also be found on all mucous membranes, where they increase the risk of malignancy.
What types of papillomas exist?
Papillomas are divided by its size into:
Small, up to 2 millimetres
Medium, up to 5mm
Large, from 1cm and up
Although they are extremely benign in nature, their size can cause problems. Blood vessels of a soft lump are located in its stalk. If the stalk is pinched, the papilloma will become very swollen, red and start to hurt. In that case it is necessary to remove it. From time to time, a dermatologist should check whether it is really a papilloma or some other type of lesion.
Some new skin discoloration, painless and without redness, may require immediate dermoscopic examination to determine if it is a more serious problem that would require an urgent treatment. Initial basal cell epithelioma as well as unpigmented melanoma may initially resemble papilloma or fibroma.
Papilloma removal – Methods
Papillomas can be removed using:
Papilloma removal using radio frequency is the most precise and the healing process is the fastest. Under local anaesthesia, applying a cream or adding lidocaine with a needle, a stalk of a skin tag is cut off at the base or, if it is small, the surface of the skin tag is touched and it evaporates. A small scab forms and falls off in a few days.
Removal of papillomas with liquid nitrogen is somewhat more complicated, often requiring several visits. It consists of freezing the base of a papilloma and its spontaneous falling off with the decay of the stalk.
Surgical removal of the papilloma is performed when its base is large and the scar would be unacceptable.
Surgery is much more often resorted to if there is a suspicion that the lesion could be some other type of tumour. A size of skin tag exceeding 5 mm could be an indication for pathohistological analysis, especially if the patient arrives with an inflamed skin tag and redness around its base.
Are any complications encountered after removal?
Removal of papillomas or skin tags is usually completely harmless and passes without any complications.
If it is not adequately removed, depending on the size or location, an infection may occur but it can be easily resolved. If a large papilloma is removed with liquid nitrogen, very unpleasant bleeding can occur.
It is never advisable to wrap the threads around the skin tag, something that patients often do at home, or cut it with scissors. This can lead to painful swelling, infection or bleeding.