One of the most common things patients say to me in consultation is “I don’t even know what to call this.” That is completely normal. Most people have never had a reason to learn the difference between a skin tag and a fibroma, or a cyst and a lipoma, until suddenly they have one and want to know what it is.
This guide is meant to help with that. Below are the lesions we see most often in clinic, what they tend to look like, why they happen, and how Dr Andrew Welch treats them. If you can see yourself in one of these descriptions, that is a good starting point for a conversation, though nothing here replaces an actual assessment. Skin lesions can look similar to each other and occasionally something that looks harmless needs a closer look, which is exactly why every lesion we remove is sent for histology.
Skin Tags
Skin Tag
These are small, soft growths that usually hang off a thin stalk of skin. They are most common around the neck, in the armpits, under the breasts and around the groin, anywhere skin rubs against skin or clothing. Some people seem to get them for no obvious reason at all, and there is often a family pattern to it.
Skin tags are entirely harmless. They just tend to be one of those things people would rather not have, especially if they catch on jewellery or a razor.
Treatment: Removed surgically under local anaesthetic. Quick, single appointment, immediate result.
Moles
Mole
Most of us have a scattering of moles and the vast majority are completely benign. Patients usually come to us for one of two reasons, either the mole is in an awkward spot and catches on things, or its appearance has started to bother them, or occasionally it has changed and they want it looked at properly.
This is the one area where I would say do not try to work it out yourself from a photo online. Any mole that has changed in size, shape or colour, or that has started to itch or bleed, needs a proper look before anything else.
Treatment: Dr Welch assesses the mole and either removes it surgically or advises on next steps. Every excised mole goes to the pathologist, no exceptions.
Fibromas
Fibromas
Fibromas are small, firm lumps of fibrous tissue. Like skin tags, they tend to turn up in areas of friction, the neck, armpits, groin and under the breasts, though some people develop them without any obvious cause.
They are benign and painless, but their raised texture means clothing and jewellery tend to find them.
Treatment: Surgical removal under local anaesthetic, usually resolved in a single visit.
Cysts
Cyst
A cyst is a closed sac under the skin, often filled with a soft, cheesy material. They tend to appear on the scalp, face, neck, back or chest and can grow slowly over months or years. Most are painless unless they become inflamed or infected, in which case they can become tender and red.
I would say this is the lesion patients most often try to deal with themselves, and I would gently discourage that. Squeezing a cyst rarely gets everything out and can make it more likely to become infected or to come back.
Treatment: Surgical excision, removing the sac itself rather than just the contents, which is the only way to properly prevent recurrence.
Lipomas
Lipoma
Lipomas are soft lumps of fatty tissue that sit just under the skin. They are usually slow growing, painless and move slightly under the fingers when pressed. They can appear almost anywhere on the body but are common on the trunk, arms and shoulders.
They are benign, but a lipoma that keeps growing or that sits somewhere it constantly gets knocked or rubbed is a reasonable thing to have removed.
Treatment: Surgical removal under local anaesthetic. Larger lipomas may need a slightly longer procedure and a few more stitches.
Granulomas
Granuloma
Granulomas are small areas of inflamed tissue that can develop after a minor injury, an ingrown hair, or sometimes for no clear reason. They often look red or pink and can bleed relatively easily if knocked, which tends to be what prompts patients to have them looked at.
Treatment: Surgical removal, with the tissue sent for histology as standard.
In-growing toenails
Ingrowing Toenail
This is one of the few things on this list that is genuinely painful rather than just cosmetically bothersome. It happens when the edge of the nail grows into the surrounding skin, causing redness, swelling and often infection if left untreated.
Treatment: Minor surgical correction of the nail edge under local anaesthetic, which resolves both the pain and the underlying problem rather than just treating symptoms.
Cherry angiomas
Cherry angiomas
Cherry angiomas are small clusters of dilated capillaries that show up as red or purple bumps, most often on the chest and back. They tend to increase in number as we age and are extremely common, most people will have at least one or two by middle age. They are entirely harmless, just sometimes a bit unsightly.
Treatment: These are not removed surgically. Our aesthetic therapists treat them using laser or hyfrecator technology. It is quick, with immediate results and no downtime.
Thread veins
Thread veins
Thread veins, also called telangiectasia, are the fine red or purple lines you see just under the skin surface, most commonly on the face and legs. They develop as skin and blood vessels lose elasticity with age, and hormonal changes from pregnancy or the menopause can bring them on too, which is why women tend to notice them more than men.
Treatment: Laser or hyfrecator treatment with our aesthetic therapists. Once a vessel is treated it will not return, though new ones can form over time if you are prone to them.
Spider naevi
Spider Naevi
Spider naevi get their name from their appearance, a small central blood vessel with fine ones radiating outward like a web. They can develop after an injury, from sun exposure, hormonal changes, or occasionally as a sign of liver disease, so if you notice several appearing at once it is worth mentioning to your GP.
Treatment: Laser or hyfrecator treatment with our aesthetic therapists, usually one to two sessions depending on size.
Cherry angiomas, thread veins and spider naevi do not need surgery
These three are grouped together because they behave the same way. They are small clusters of blood vessels rather than growths of tissue, so Dr Welch does not need to be involved and there is no cutting or stitching. Our aesthetic therapists treat all three using laser or hyfrecator technology in a quick appointment with no downtime, which is a different pathway to the surgical lesions described above.
If you recognise something here
Comparing your own skin to photographs only gets you so far, and I would rather you came in and let us have a proper look than try to self-diagnose from a screen. Book a consultation with Dr Andrew Welch and he will tell you honestly whether what you have needs treating, and what your options are.
