Skin lesions are broadly divided in pigmented lesions and non-pigmented lesions. Pigmented lesions cause discoloration of skin and include both benign and malignant lesions. Most of the pigmented lesions of skin are benign in nature. They are also called moles. Pigmented lesions that are malignant are called melanoma. The pigmented skin lesions occur as a result of abnormalities or rapid division of melanocytes, which are skin cells producing a skin pigment called melanin.
Moles can occur on any part of the skin surface and are usually flat or raised growths with brown or pink coloration. Moles are usually symmetrical in appearance. Moles that are asymmetrical have a tendency to turn cancerous. Moles are also called nevus and are subcategorized into different types depending upon the layer of skin that is affected. Junctional nevi are formed in epidermal cells whereas compound nevi are formed in both the dermal and epidermal layer. Dermal nevi are moles that are formed in the cells of dermal layer of skin. However, they are not visible because they are situated beneath the epidermis.
Other commonly occurring pigmented benign lesions of skin are blue nevus, congenital nevus, dysplastic nevus and Spitz nevus. Birthmarks, sun spots and freckles are also some types of pigmented skin lesions. Some infections are known to give rise to pigmented benign skin lesions.
Appearance of malignant pigmented skin lesions or melanoma can be varied. Melanomas can not be differentiated from other common types of skin lesions based on their appearance alone. Any lesion that is suspected to be malignant needs to be investigated by doing a skin biopsy to rule out malignancy.
Patients may also have melanomas that are present since long time, sometimes for several years, but grow in size or change in appearance and turn malignant.
Any change in pigmented lesions like change in color, increase in size, irregular borders or tendency to bleed should raise a suspicion about them being malignant melanomas. They are raised above skin surface and are irregular in shape. They are black or dark brown in color. Some may be red or blue in color. Some melanomas have a tendency to ulcerate. It should be remembered that early detection of these lesions is very important to treat the condition successfully.
Different modes of treatment for the pigmented skin lesions are mentioned below:
Wait and Watch Policy:
Some benign skin lesions are completely harmless. Patients can ignore them unless they are cosmetically disfiguring. Patients should take care to notice any change in the appearance of these benign lesions and should consult a physician if any change in size and color of the lesions is noticed. Wait and watch policy is the best solution for the management of benign pigmented skin lesions.
Use of topical agents can help in the treatment of benign pigmented skin lesions. Local application of corticosteroids can help in lightening the color of pigmented lesions. Local injection of corticosteroids can also produce the same effect. Anti-histaminics and anti-inflammatory drugs can be useful in relieving the redness and itching in these lesions. However, use of meditations for treating malignant pigmented skin lesions should be avoided. The malignant lesions are treated by surgical intervention only.
Treatment of Pigmented Lesions with Laser Therapy:
In pigmented skin lesions the affected skin looks darker than the surrounding normal skin due to abnormalities of melanin production. This leads to increased concentration of melanin pigments in a localized part of skin. Laser therapy can help in these cases by producing a beam of light that is directed towards the affected skin. This light is absorbed by melanin pigments in skin. The light is then transformed into heat that is absorbed by skin cells leading to their destruction. However, the normal skin surrounding the lesion is left unaffected during the procedure.
The skin surface should be cleaned well before the therapy begins. Any make up over the part should be removed completely with soap and water and the skin should be patted dry before the therapy. Taking photographs of the part to be treated before the therapy can help in monitoring the progress of the lesion after the treatment. Also, if the lesion is over a hairy part of skin, the skin should be shaved properly before the treatment to avoid chances of infection. The lesion should be inspected well by the practitioner before the therapy to determine the parameters and caliber of laser treatment to be used for the particular patient.
In the procedure, the physician will direct the laser beams to the skin surface to be treated with the help of a small handpiece.
These laser pulses are preceded by a cooling spray of short pulse. The time needed by each session depends upon the size of lesion. It may take few minutes to an hour for each session. The strength of the laser pulse used can be altered depending upon the patient’s comfort and response of skin to the beams. Patients may feel each light pulse like a flick of elastic band. The treatment procedure is painless. General anesthesia may be needed in some patients who are very anxious or for small children.
The outcome of laser therapy is dependant upon the depth of skin lesion and color of lesion.
However, the overall results of the treatment remain unpredictable. Hence, it is advisable to try the treatment over a test patch before going for the treatment of full affected part. This may not be practically possible in case of very small lesions.
Patients may need several sessions of laser therapy for the complete disappearance of the lesion. Patients can notice the lesion becoming lighter in color after the first sessions itself. The treatment needs to be done with caution in people with darker skin color, as the therapy may leave the skin hypopigmented permanently. Use of sun protection cream having sun protection factor of atleast 30 should be done for minimum 6 weeks following the treatment to reduce the side effects like hypopigmentation. Also, the skin should be protected from hazardous effects of sunlight for 6 months after treatment.
Patients may suffer from crusting and blistering of skin after laser therapy. Care should be taken to protect the eyes during the procedure, to prevent damage to eyes due to laser beams. Also, patients should avoid picking at or scratching the treated part for avoiding permanent scarring. Redness and swelling over the treated part may occur after the therapy, which lasts just for 1-2 hours. The skin may look darker immediately after the treatment and looks shriveled. Applying ice packs over the part can help in reducing these after effects. The part treated looks crusty for few days after the treatment. Once the crusted part of skin falls off, the skin grows back with a normal pink color.
Surgical Excision of Skin Lesions:
This is particular treatment needed for malignant skin lesions. Benign pigmented skin lesions that are very large in size and are cosmetically disfiguring can also be removed surgically. The surgical excision of lesions is done under local anesthesia. For removal of malignant lesions, care should be taken to see that complete excision of the lesion is done without leaving behind any malignant cells. Also, the affected lymph nodes are removed during the procedure to avoid spread of malignancy. The time required for the procedure depends upon the size of lesion. Proper dressing of the wound is necessary after the procedure to ensure healthy healing of wound and to prevent infections.
Some other procedures that can be preformed for treatment of pigmented skin lesions are cryotherapy and freezing techniques.
An early detection of lesion with proper diagnosis is necessary for effective treatment of pigmented skin lesions.