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What is the best way to remove intradermal neva in a fourteen year old girl?

Jul 2012
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Practicing since : 1993
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What is the best way to remove a id sheek intradermal naevae (neva) in a 14 year old girl?
Posted Wed, 5 Sep 2012 in Skin Hair and Nails
Answered by Dr. Praveen Rodrigues 1 hour later
Hi there XXXXXX. Is it possible to upload a clear image (close-up) of the lesions?
These are stubborn lesions to treat. In the past, i preferred using cryotherapy followed by an excision biopsy. However assuming it is on your 'cheek', then nowadays an Erbium or Co2 (carbondioxide) laser excision is probably your best option but for this, the dermatosurgeon or plastic surgeon on the ground closest to you will be the best to opine. Dr Praveen
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Follow-up: What is the best way to remove intradermal neva in a fourteen year old girl? 2 hours later
Typo as the naevae was actually 3.5mm and I have been previously informed that there is a 100% chance of a change in skin pigmentation as a result of using the laser i.e. hyper or hypo pigmentation which to me means that it could easiily end up looking visually worse than the original problem, esp with the chance of tea intradermal naevae growing back.
Answered by Dr. Praveen Rodrigues 19 minutes later
Hello Again. The fact remains that 'intradermal nevi' are stubborn chappies & the recurrence rates are high despite one's best efforts. As for side effects, I disagree. I concede pigmentary inconsistencies may be an issue but believe you me, there is NO surgery sans side effects whatever the condition or whoever the surgeon or whatever tthe mechanism used. A bad workman always blames his tools. It all depends (i reiterate this) ON THE PERSON/SURGEON on the ground treating you. It is his/her comfort with his/her instrument of choice or skill that is paramount to the outcome!! Online, we can only guide you in the right direction. However, an informed & collective decision will have to be taken together with your treating dermatologist/surgeon. Personally, I would still opt for mild cryotherapy followed by an exscision of the lesion as nowadays, one can close the owund using subcutaneous sutures with topical 'steristrips' on the surface thus leaving a 'minimal' scar sans any pigmentary issues. Having said that, your treating doctor has to be comfortable with this line of managment. While lasers do have the mentioned side effects of residual pigmenation, it is by no means would do any laser surgery in that case. Also, whatever the options, the nevus may regrow but with lasers, studies document the chances of total remission are better :) I would recommend taking two to three opinions on the ground (NOT online however good a doctor yours truly or anyone else may be) & then go with what is in your best interests. Sometimes, more the research, more the angst. In medicine we have a dictum: Do No Harm! I wish you the very best & hope i have provided a clear view point & reassured you that your treating doctor may just know what he is doing & you will do the best for your daughter & leave the rest to the 'Higher Powers'! I would appreciate a review & feedback should you be satisfied & do ping us with the end result. Cheers & GodSpeed!!
Dr Praveen Rodrigues MD Dermatologist & Cosmetologist, XXXXXXX Hospital, Bangalore, India.
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Follow-up: What is the best way to remove intradermal neva in a fourteen year old girl? 20 hours later
My problem is I have already seen 2 dermotolgists who gave completely different advice + a plastic surgeon who suggested cut out but no discussion re possiblity of skin graft for the middle cheek area where it is to be removed from. I am told that is often done due to muscles etc below???
The latest visit re the laser had the doctor only comment on possiblity it may not work nd post surgical treatment. When I rang back re side effects I was given a very brief summary of listed skin infection/scarring etc side effects but no further explanation on whach I was expecting to get more detail. I am hoping to hear back to discuss in more detail as I believe this is a more dated erbium laser and again the year is quite relevant. I have asked since then and have not been given even the consent forms we are expected to sign up front on the day - and this makes me v suspiscious as they even are denying givein them to me.Surely if the consideration was no harm ther would be full disclosure and explanation up front???
In my country you are stature barred from suing for medical malpractice except for the most extreme of abuses - so you need to be sure up front. I take it that I should walk away form this partiuclar surgery and try elsewhere due to their lack of explanation as to riska nd proviion of documentation up front?
Answered by Dr. Praveen Rodrigues 2 hours later
Hi again XXXXXX. Let me try & be more 'specific'. Walk away from the procedure at this particular set-up you mentioned as you do not seem confident of their abilities. If one starts with the slightest mistrust, then that marriage is doomed! I am not a plastic surgeon & hence not best suited to opine on the 'skin graft' post surgery albeit i would concede that will have to be decided by the treating surgeon depending on the size of the excised areas & the cosmetic appearance envisaged therof. I agree you need a full disclosure & explanation up-front, so even if this centre has the 'right' or 'updated' Erbium laser, if you are in the least bit 'doubtful', in your daughter's interests, stay away. Take a second opinion on the ground. I just reiterate that in the end, the tool (laser in this case) while important, is NOT as important in a surgical line as the skill & confidence of the 'surgeon' concerned. So do go with someone who inspires confidence in you at the outset. Dont worry too much about the equipment used; leave that to the doctor using it. You will always get conflicting opinions & you will have to make an informed choice on the ground. Yes there should be a full disclosure & explanation from the treating doctor.
I do hope i have been lucid & wish you well on your quest to find a doctor in your country who inspires confidence & ends up doing a good job whatever method he/she recommends. I empathise with you & dont worry..things have a way of working out. Take a step back for a week or two & then re-consider. Cheers!
Dr Praveen Rodrigues MD Dermatologist,Cosmetologist, Venereologist, XXXXXXX Hospital, Bangalore.
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