About Laser Treatment of Moles and Cysts

Moles

Moles can take many different forms and can be found in many places on the body. There are several different types of moles, which vary both in their appearance, as well as where the mole cells are specifically located in the skin. Some of the more common moles include:

• Dermal moles: These are usually soft, skin colored, and raised above the surface of the skin.
• Junctional moles: These are usually completely flat, small, and dark brown in color.
• Compound moles: These will usually have both flat and raised components to them (a cross between a dermal and a junctional mole) and can range in color from tan to dark brown.
• Blue mole: These moles are blue-gray or blue back in color and tend to be more commonly found on the face, scalp, hands, and feet. Although blue moles can be found on anyone, they tend to be more common in individuals of Asian descent.

The options for treating moles include surgical excision, laser treatments, or simple observation if the appearance and behavior of the mole are benign. Junctional moles are appropriate targets for laser treatment, while the other types of moles must be surgically excised if they are to be completely and definitively removed.  

Cysts

Like moles, cysts also come in different varieties, and can be found in many different locations on the body. Most cysts contain keratin (what our skin and hair is made of), oil (sebum), or very often a combination of both. Because a cyst consists of a sac that is lined by cells or glands that create its contents, definitive treatment requires complete removal of both the sac and its contents. Some common types of cysts include:

• Epidermal inclusion cyst: This is the most common type of cyst. These cysts will often have a connection to the skin’s surface (a small punctum or opening that you can see overlying the cyst), through which a white, cheesy, malodorous substance can often be expressed. Epidermal inclusion cysts can be found nearly everywhere on the body, including on the genitals.

• Pilar cyst: This cyst is made out of hair follicle elements, and as a result is found on the scalp. Some people will have a tendency to develop multiple pilar cysts.

• Dermoid cyst: This type of cyst arises as a result of an alteration in fetal development that traps ectodermal elements – such as skin cells, sweat glands, oil glands, and sometimes hair follicles. Dermoid cysts are often first observed at birth or shortly thereafter and are usually located on the head. Because these cysts may have an intracranial connection, it is important to obtain appropriate imaging prior to surgical excision.

• Steatocystoma: A steatocystoma is similar to an epidermal inclusion cyst, but instead has a sac that is lined with sebaceous (oil) glands. Consequently, a steatocystoma will contain an oily substance, rather than the keratinaceous material that is found in other types of cysts. When a person develops several of these cysts, the condition is known as steatocystoma multiplex. While steatocystoma multiplex can occur randomly, some people will develop these as the result of an autosomal dominant mutation, in which case a person will report that one (or even both) of their parents had similar cysts. The treatment for a solitary steatocystoma is surgical excision, laser ablation is a more appropriate option for steatocystoma multiplex.

• Vellus hair cyst: This is a cyst that contains small vellus hairs in it, in addition to keratin and sebum. Some people may develop multiple cysts in a short period of time, referred to as eruptive vellus hair cysts. The treatment for a solitary vellus hair cyst is surgical excision, while laser ablation is a more appropriate option for eruptive vellus hair cysts,
• Scrotal calcinosis: This occurs when small, firm, flesh colored to whitish/yellow nodules appear on the skin of the scrotum. Although these cysts are benign, individuals affected are often bothered by their appearance, and will hence elect to have them surgically removed.

The definitive treatment of a cyst is surgical excision. However, in cases where cysts are small, numerous, and have a tendency to continuously develop, laser ablation is a preferable option. Cysts that are good candidates for laser ablation include:

• • • Steatocystoma multiplex
    • Eruptive vellus hair cysts

How do I know which moles are good candidates for laser removal?

While many moles and cysts are benign, many people will seek to have them removed simply because they do not like the appearance of them. Moles that are good targets for laser removal are junctional moles, which appear completely flat, small, and dark brown in color. As long as these moles have been examined by our board-certified dermatologists and are confirmed to be junctional moles that do not have any concerning features or behavior, they can be removed with pigment directed long-pulsed lasers such as the Quanta Light Evo^Ò or the Quanta Thunder^Ò. The pigment in the mole absorbs the energy of the laser, which causes the mole to peel off during the days to weeks following treatment.

It is important to identify whether the spots that you are looking to have treated are truly moles, or whether they represent other types of skin growths. Some benign spots that are frequently mistaken for moles include seborrheic keratosis, dermatosis papulosis nigra, melasma, as well as sun spots and freckles. Our board-certified dermatologists will carefully evaluate the spots that you are looking to have treated to identify whether they are in fact moles, whether they are the type of mole that can be removed with a laser, as well as whether it would be more prudent to perform a biopsy due to the presence of any suspicious features or behavior.

How do I know which cysts are good candidates for laser removal?

Like moles, most cysts are benign and do not require treatment. However, in the case of steatocystoma multiplex and eruptive vellus hair cysts, which can be numerous, small, and widespread on the body, many people will seek to have them removed because they do not like their appearance. These types of small and numerous cysts are good candidates for laser ablation because it minimizes the amount of trauma that your surrounding skin is subjected to, and it leaves you with a much smaller scar (if you are left with any at all).

How are cysts removed with laser?

At the Gateway Aesthetic Institute and Laser Center, our board-certified dermatologists use a state-of-the-art erbium laser to precisely ablate small openings in the surface of your cysts, through which the contents and sac can be evacuated. The spot size that is used during this process is less than 1 mm in diameter, and thus allows for extremely careful treatment of the cyst, while sparing damage to the surrounding skin. Although some physicians will recommend treating cysts with incision and drainage, or surgery, these approaches are not the most practical when dealing with steatocystoma multiplex or eruptive vellus hair cysts. Some potential complications associated with incision and drainage and/or surgery on multiple small cysts include scarring, keloid formation, and pigmentary damage to the surrounding skin (either hyperpigmentation whereby the skin becomes darker, or hypopigmentation or even depigmentation, where the pigment is temporarily or permanently destroyed). Erbium laser in the hands of one of our extremely skilled physicians is the most effective way of treating steatocystoma multiplex and eruptive vellus hair cysts, giving you the best cosmetic outcome while leaving your surrounding skin untouched.

What happens if I don’t treat my moles or cysts?

In the majority of cases, it is completely fine to not treat your moles or cysts. However, if your cysts have a history of becoming infected/inflamed, and/or have required multiple incision and drainage procedures in the past, laser ablation may be a preferable option. Many moles can also be left untreated, but if any start to exhibit changes in color, border, size, shape, or other new symptoms, our board-certified dermatologists may recommend surgical excision so that the mole can be sent for evaluation. 

Why trust Gateway Aesthetic Institute and Laser Center to treat my moles or cysts?

Our board-certified dermatologists at the Gateway Aesthetic Institute and Laser Center have decades of experience performing laser treatments to remove a wide variety of benign skin growths using the most advanced erbium and pigment directed lasers. While many practitioners may counsel you to leave your moles or cysts untreated because they are benign, our physicians understand your desire to improve your appearance, and will work with you to identify the best course of action to address your concerns. Should you elect to proceed with laser removal of your moles or cysts, you can trust that you will be receiving expert care from our highly skilled team of physicians, who pride themselves on offering safe, efficacious, and precise treatments with the most advanced lasers. Finally, our board-certified dermatologists will conduct a careful evaluation of the areas that you are looking to have treated, prior to initiating any intervention. This is important because some moles and even cysts may exhibit features concerning for malignant transformation.