Paediatric Skin Lesion Removal
As a Paediatric Plastic and Reconstructive Surgeon Dr O’Mahony frequently treats children of all ages who have lesions causing clinical, physical, psychological or aesthetic concerns. These include congenital lesions they were born with or lesions that have developed or progressed over time.
If your child has a lesion causing you or them concern Dr O’Mahony would advise you to first consult with your General Practitioner, Paediatrician or Dermatologist. They can then assess if you need to consider removal of the lesion and refer your child to her.
It is important to be aware that all surgeries, even minor procedures, on children are undertaken under general anaesthetic in hospital. This is required in order to safely perform the operation without your child being fearful of their surroundings, experiencing pain, being held down, moving during the procedure or developing a fear of Doctors or Hospitals. Dr O’Mahony works with highly skilled Paediatric Anaesthetists who have extensive experience in safely providing anaesthesia for children to ensure a safe and relaxed experience for you and your child.
The information below explains some of the more common lesions Dr O’Mahony removes from children, this list is not exhaustive.
Dermoid Cysts/Angular Dermoid
During facial development when the sections of the face fuse in utero there can be entrapment of skin elements below the surface that develop into cysts. These are most commonly found around the eye sockets, although they can occur on other parts of the face or head.
Dermoid cysts can also develop on the body after birth or into adulthood and their origin is not usually related to in utero development.
Facial and head lesions commonly develop directly on the surface of bones and as a result an indentation is formed in the bone. After removal of the lesion this is rarely evident. Occasionally there is a gap in the bone underneath the cyst and a part of the cyst is passing through this into the inside surface of the bone. Dr O’Mahony will commonly ask your child to have an ultrasound scan to examine the underlying bone before proceeding with surgery. If the cyst is found to be inside the bone surgery can still be undertaken but Dr O’Mahony would usually need to combine her procedure with a Neurosurgeon.
Dermoid cysts are removed because they are clearly visible as a mass on the face, and to reduce the small risk of infection of the cyst. If your child is born with a dermoid cyst Dr O’Mahony would usually suggest waiting to remove the lesion until he/she is older than 12 months unless it is blocking you child’s vision.
Naevus Sebaceous is a form of congenital mole that has a pale yellowish waxy appearance. It may have a slightly raised appearance compared to the surrounding surface. If it is in a hair bearing area such as the scalp no hair grows within it. This type of lesion has a risk of developing Basal Cell Carcinoma ( a skin cancer) within it in young adulthood and is therefore usually removed when recognised.
Congenital Melanocytic Naevi
These lesions are brown in colour and range from quite small to giant, covering an entire limb or torso. They often have dark hairs growing from them. The lesions can be very visible and difficult to camouflage causing social anxiety for children, particularly if the face is involved. Congenital Melanocytic Naevi carry a very small risk of change to melanoma, this risk is too small to accurately quantify. Removal of these lesions is undertaken to reduce their visibility and to remove very the small risk of future malignant change. Due to the size of these lesions relative to the area of normal skin around them, even small and medium sized lesions may require staged procedures or reconstructive techniques to facilitate removal. Large lesions may not be possible to remove and Dr O’Mahony would usually advise surveillance under the care of a dermatologist and removal of any changing or concerning areas.
Pigmented or other Moles
Dr O’Mahony removes moles from some children if they are experiencing clinical concerns such as changes to the lesion or significant social anxiety. If there are concerns that skin lesions maybe cancerous or pre cancerous Dr O’Mahony would strongly advise assessment by a Dermatologist prior to consultation with her as Dermatologists have examination equipment that can better assess the lesion and can then suggest if surgery would be advisable. Routine removal of entirely normal moles is not required for skin cancer prevention as many moles are not pre cancerous.
It is not possible for any Surgeon to remove a scar or to operate without leaving a scar. Some scars that were created in the setting of trauma such as falls or dog bites can be improved later with surgical removal and re suturing. Many scars cannot be improved upon. Dr O’Mahony would rarely revise a scar before 12 months has passed since the injury as the scar remains active prior to this time and re operation would risk creating a worse scar. If your child has been referred to Dr O’Mahony for scar revision she will commonly not see him or her until the scar is closer to 12 months old. Non surgical scar management advice in the first 12 months or beyond can be sought from your GP or an occupational therapist.
Dr O’Mahony will be happy to consult with any of her own patients at any time if they have questions or concerns about their surgical scars after an operation she has undertaken.