Preparation

• Chlorhexidine (or approved cleansing agent)
• Sterile gloves
• Goggles
• 10-mL syringe
• 27g needle
• Xylocaine 1%
• Forceps with teeth
• Gauze
• Cotton-tipped applicator
• Topical antibiotic – optional
• Dressing (ex: Band-Aid)
• No. 15 scalpel or iris scissors (Snips Technique)
• High-temperature cautery (Electrocautery Technique)

Procedure Steps

Step 1: Cleanse area with chlorhexidine or other approved cleansing agent

Step 2: Inject 1-2mL of xylocaine with or without epinephrine into the base of the skin tag to create a wheal

The wheal raises the lesion and allows it to be propped up by the injected anesthesia so it can be better stabilized and visualized during the procedure. Test sensation with needle prick prior to beginning the procedure.

Note: Anesthesia may not be required for removal of small skin tags (<2mm at the base).

Step 3: Pull skin tag taut

Grasp the skin tag at the largest part with a toothed forceps and gently pull taut to visualize the stalk base.

Step 4: Detach skin tag at base of stalk

Electrocautery Technique

• Activate the electrocautery tool to heat tip.
• Apply gentle pressure with repeated, quick motions until the stalk detaches.
  • Firm continued pressure with heat can result in pain and/or burns.

Snips Technique

• Hold a No. 15 scalpel blade tangential to the skin surface.
• Slice the stalk using a forward smooth sweeping stroke of the blade going as close to the base of the stalk as possible.
• Alternatively, iris scissors can be used to cut the stalk as close to the base as possible.

Step 5: Achieve hemostasis

• Sustained firm pressure at the site is usually sufficient to achieve hemostasis.The electrocautery technique results in minimal bleeding as the vessels are cauterized during removal of the skin tag.
• Alternatively, a hemostatic agent (such as silver nitrate or aluminum chloride) can be applied using a cotton-tipped applicator.

Video

Aftercare

• Keep the wound clean and dry.
• Observe for signs and symptoms of infection:
  • Increase in pain after 24 hours
  • Increase in temperature
  • Redness or swelling
  • Yellow or greenish discharge
  • Foul odour
• Discomfort can be treated with acetaminophen every 4-6 hours.
• Redness to the site is common and will lessen over time.

Patient Education

Follow-up

• Return if signs and symptoms of infection are present.
• Arrange for a wound check in 1 week as needed (e.g., poorly controlled diabetes).
• Skin tag may reappear at site it was originally removed.

Key Takeaways

• Local anesthesia may or may not be required depending on the size of the skin tag to be removed.
• Removal is typically done due to skin irritation or for cosmetic effects.
• Local cautery with heat or a hemostatic agent may be required following removal.