Treatment
Liver spots can be removed using various methods. A dermatologist can determine whether this is also useful in individual cases by means of a biopsy (tissue removal) and depends on the findings. For example, if the mole is harmless, its removal is not necessarily indicated from a medical point of view.
However, if the sample is diagnosed as malignant skin cancer (malignant melanoma), it is recommended to remove the mole to prevent the disease from spreading further. In this case, the mole should be removed surgically, generously and with a certain safety margin. (see: Liver spot and skin cancer) Other methods, such as the laser procedure or a special light procedure serve purely to remove liver spots from a cosmetic point of view.
No statement about the malignancy of the liver spots is possible, because the tissue is irreversibly destroyed and afterwards no tissue removal from this area is possible. A degeneration of the affected mole must therefore be excluded in advance. In the laser procedure, the area is first disinfected and a local anaesthetic is applied.
The laser beams then penetrate the top layer of skin and produce heat. This heat energy destroys the melanin, the substance responsible for the dark color, which is formed in the liver spot too much. Since the laser beams can be applied very precisely, the surrounding tissue is not damaged.
Directly after the treatment, the mole often looks a little darker than before, but scabs after a few days and then heals without any problems. All in all, the laser procedure is a very gentle method, which is well suited, but also exclusively for cosmetically disturbing liver spots. The method with light is the IPL method with intensive pulsed light.
The principle is very similar to that of laser beams, namely that high-energy light destroys the melanin in the uppermost skin layer and thus makes the mole optically disappear. The cells of the surrounding skin tissue are not damaged.This method is also only suitable for the treatment of cosmetically disturbing liver spots, not for the treatment of degenerated liver spots, as the penetration depth of these light rays is not deep enough for this. Malignant liver spots should always be removed surgically.
After sufficient disinfection and anesthesia of the surgical area, the mole is cut out with a scalpel with the necessary surrounding safety distance. Small incisions do not require sutures, but if a somewhat larger mole with surrounding structures is removed, a few stitches may be necessary. Very small liver spots can also be punched under certain circumstances.
The patient himself usually does not notice this procedure and can go home immediately after the treatment. An inpatient stay for this is usually not necessary. Only in the following two weeks, no sports should be done and no movements should be made that put a particular strain on the operated skin area.
In addition, adequate wound hygiene should be ensured. Under no circumstances should liver spots be cut out on their own. On the one hand, this can lead to cosmetically very ugly scars, but the area could also become infected and lead to further complications.
Both the final assessment regarding the malignancy and the removal of liver spots should always be left to a specialist, i.e. an experienced dermatologist. Moles have a very low risk of degeneration and therefore do not usually pose a health risk. However, as soon as there is a suspicion that the mole might be malignant and skin cancer could develop from it, it should be removed.
There are various methods for this.
- Surgical removal: The removal of liver spots with a scalpel, i.e. excision (excision=cutting out) is a method that is used quite often, since one can then send the suspicious skin area to a laboratory and thus obtain proof whether it was really a malignant liver spot. The procedure for surgical excision is as follows: The area to be operated is generously disinfected to prevent inflammation of the wound.
Then the skin is injected with an anesthetic (local anesthetic). This has two functions. On the one hand, the area is anaesthetized and the operation can be performed painlessly.
On the other hand, the liver spot is lifted by the injection of fluid and can thus be removed more easily. If the local anesthetic is effective, the mole is cut out with a safety margin of a few millimeters. The dermatologist will take care to reach the entire nevus even in the depth.
Then the wound is sutured up according to its size. After one to three weeks, the stitches can be removed and the treatment is finished. Usually a small scar remains.
- Especially if a mole is to be removed for cosmetic reasons only, patients want to avoid the surgical method, as it almost certainly leads to a scar.
It is also possible to have the mole removed by laser treatment. This method is primarily suitable for cosmetic surgery, as the mole is destroyed and no material can be obtained for laboratory examination (no prognosis for possible malignancy). Laser treatment does not open the skin, so the risk of wound healing disorders and inflammation is minimized.
In addition, there is usually no or very little scarring. A disadvantage, however, is the high cost of the procedure, which is almost never covered by health insurance. There is also a low risk that the mole is not completely removed and therefore grows back.
The laser procedure for the removal of liver spots is only used if the removal is for purely cosmetic reasons.
It is in no way suitable for treating malignant changes, since tissue removal for further diagnostics is no longer possible with this method. The irradiated tissue is irrevocably destroyed and can therefore no longer be used for evaluation. However, if a malignant change can be safely ruled out, the mole to be removed is first anaesthetized and then irradiated.
The result is not always exactly predictable. It is possible that the mole almost completely disappears, but it is also possible that it only fades a little or even reappears after some time. A good and comprehensive consultation with a specialist is therefore of great importance, especially for exposed parts of the body such as the face.Possible complications of this method are scarring, localized burning or other tissue damage or nerve damage, which can lead to sensations in the affected area of skin. An infection following treatment is also conceivable, although an antibiotic-containing ointment is usually used prophylactically. It is therefore important to have a laser treatment performed only by an experienced specialist and, if possible, in a designated center to prevent further complications.
