Wrong treatment for intradermal nevus on the tip of my nose, what can I do to make it better? (Photos)

Question

6 months ago, I have been pushed by an aesthetician (who presented themselves to me as a dermatologist) to treat a deep intradermal nevus (diagnosed as such by several dermatologists since) with a plasma pen. Since then, the mole grew back and is much more visible than before, since the skin that was covering it has been burned. The mole is still somewhat skin color, but the bump is much more prominent than before - which affects me as lot. I would give anything to be back where I was before the procedure.  Since then, I have seen 2 dermatologists and 1 cosmetic surgeon: one recommended Erbium laser, and two a shave removal. However, I'm super doubtful since this mole seems very deep, I'm afraid of irritating and making things worse again. All of them assessed the mole as benign. I would like to find the best solution to make it as unnoticeable as possible (colour and relief). I have also considered just doing resurfacing laser on it, in the top of growing some skin back, but I’m afraid it won’t be enough. I'm open to any suggestion and advice. Thank you.

Anna Chacon, MD, FAAD · Answer

I can understand why this has been so upsetting. When you were originally comfortable with the appearance of the mole and then a treatment changed the surrounding skin, it is natural to want to get back to how things looked before.

If the lesion has been evaluated by multiple dermatologists and a cosmetic surgeon and they agree that it is a benign intradermal nevus, the main issue now is determining the best way to improve its contour while preserving as much normal nasal skin as possible.

A plasma pen can injure the superficial skin overlying a deeper nevus without actually removing the deeper nevus cells. That can leave the underlying raised portion more apparent once the surrounding skin heals. This may explain why the mole now looks more prominent to you.

Because you describe the nevus as relatively deep, I understand your hesitation about simply treating the surface again with a laser. Resurfacing the skin alone generally would not be expected to remove the deeper component of an intradermal nevus. It could potentially improve some surface irregularity or discoloration, but it would not address the underlying bump itself.

A carefully performed shave removal can be a reasonable option for a raised intradermal nevus, even when the lesion extends into the dermis. The goal is to remove the portion creating the visible elevation while preserving as much surrounding normal tissue as possible. The exact depth of the lesion matters, however, and there is always a balance between removing enough tissue to flatten the contour and going too deep, which could create a depressed scar.

Another consideration is that intradermal nevi can sometimes recur after partial removal. If the lesion is very deep or has a broad base, the surgical approach needs to be individualized. In certain cases, complete excision may be considered, but on the nose this can create a linear scar or contour change that may be more noticeable than the original nevus. That is why I would be cautious about automatically choosing the most aggressive procedure.

Since the skin has already been injured by the plasma treatment, I would also avoid repeatedly treating the area with lasers or other destructive techniques without a clear plan. More treatment is not necessarily better, particularly on the tip of the nose where there is limited soft tissue and scarring can affect the contour.

The fact that the lesion has been assessed as benign is reassuring. Before any additional treatment, I would want the diagnosis documented and the current anatomy carefully evaluated, ideally with comparison to photographs from before the plasma treatment. The objective should be to make the bump and any residual color difference as inconspicuous as possible while avoiding another scar or depression.

In a situation like this, I would generally favor a conservative, controlled approach to the raised component rather than another superficial destructive treatment. A properly selected shave technique may provide a good cosmetic improvement, but the final decision should be based on how deep and broad the nevus actually is and how much of the visible contour change comes from the nevus versus the scarred skin overlying it.

Most importantly, try not to feel that the current appearance is necessarily permanent. Even though you may not be able to recreate the skin exactly as it was before the plasma treatment, there are ways to improve both the height and visual prominence of the area while minimizing the risk of creating a new cosmetic problem.

Wrong treatment for intradermal nevus on the tip of my nose, what can I do to make it better? (Photos)

Answers (1)

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