Skin Tag Removal

  • Review the patient'south nautical chart for potential complicating factors, e.g. keloid scars, bleeding disorders (e.g. von Willebrand), previous surgical complications, allergies to betadine/latex, electric current antiplatelet/anticoagulant medications, etc.

  • Set-up the procedure room by ensuring all necessary materials are present and easily accessible. Prepare for both cryosurgery and electrocautery.

  • Materials: Consent form, gloves, pare marker, half-dozen inch cotton swabs, container with liquid nitrogen, betadine, alcohol swab, lidocaine 2% with epinephrine, iii mL syringe, 16 gauge needle (gray), twenty gauge needle (pink), blunt dermal Bovie tip, Bovie electrosurgery device, flat forceps, specimen container with formalin, 4x4 gauze, aluminum chloride 10% solution, bacitracin, adhesive bandage.

  • Place the lesion(s) to be removed and appropriate surgical method:

    • Multiple lesions: Place a mark abreast each target lesion with a skin mark. Measure out and record each lesions' size and location. Practise not remove more xv lesions for safety and billing purposes (run into notes).

    • ONLY use cryosurgery for unequivocally benign lesions. Do NOT utilize cryosurgery for lesions with asymmetry, uneven borders, pigmentation, diameter ≥ vi mm, and/or contempo alter in appearance.

    • Any lesions with concerning characteristics (see italics above) should be removed with electrocautery and sent for biopsy. Characterization specimen container(s) and identify tissue biopsy order(s) before proceeding.

  • Consent the patient for the procedure. Discuss hazard for pain, bleeding, infection, injury to surrounding tissue, temporary swelling, permanent scarring. Inform patient that reactive scaring may may produce a lesion larger than the 1 removed. Inform the patient that multiple rounds of cryotherapy may be required to remove a lesion.

Cryosurgery Method

  • Submerse the cotton swabs in liquid nitrogen.

  • Place the cotton swabs on either side to of the lesion peduncle and compress until it frosts. Repeat 2-3 times.

  • Complete a procedure annotation and bill the procedure (see notes).

Electrocautery Method

  • Identify the lesion to be removed.

  • Clean area with betadine. Do Not use booze swabs as booze can ignite and burn the patient.

  • Set up anesthetic (lidocaine 2% with epinephrine): Clean bottle summit with alcohol swab. Insert 3 mL syringe with xvi guess needle and make full syringe. Remove the sixteen gauge needle (discard in precipitous bin) and attach a 25 gauge needle. Insert the syringe bevel-deep at the lesion edge. Depict back and insure no blood enters the needle before injecting to class a cycle under the lesion. Wait 7 minutes for lidocaine and epinephrine to accept effect.

  • Affix a blunt dermal tip to the Bovie pencil. Plow on the electrosurgery generator and fix the device to iii.0.

  • Compression the pare tag with forceps to ensure appropriate anesthesia. Utilize the forceps to lift the lesion abroad from the skin. Use the Bovie pencil to remove the lesion.

  • Place the lesion in a formalin specimen container.

  • Have 4x4 gauze and aluminum chloride 10% solution available for hemostasis if necessary. Alternatively, increase the Bovie to 6.0 to apply information technology equally electrocautery.

  • Cover the surgical site with bacitracin and an adhesive cast.

  • Verify the tissue biopsy is labeled and give information technology to the appropriate staff member.

  • Complete a procedure note, log the biopsy, and bill the procedure (see notes).

  • Call the patient once biopsy results are received and document the conversation.

Notes

  • Local anesthesia

    • Exercise Not apply lidocaine with epinephrine to peripheral appendages, east.g. fingers, toes, penis.

    • Conservatively, the maximum recommended topical lidocaine dose is 4.five mg/kg per session, not to exceed 300 mg. (The 300 mg limit applies to patients ≥ 67 kg.) For 2% lidocaine (20 mg lidocaine per mL), 15 mL solution contains 300 mg lidocaine. Reserving upward to 1 mL topical anesthetic per lesion, this results in a maximum of fifteen lesions removed per session. Fifteen is as well the maximum number of lesions that can exist billed under CPT 11200 (encounter beneath).

  • Pecker each skin tag removed (upward to 15 lesions) as 11200. For example, removal of 5 pare tags will be billed every bit 11200, 11200, 11200, 11200, 11200.