Best method to remove a 10mm raised pigmented lesion? (Photo)

Question

I had a sebhorreic keratosis treated with cryomodulation that made the spot much worse. Now I am looking for methods to remove the damage. Am I better off doing liquid nitrogen, electrodessication, or CO2, etc? Thank you in advance.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photo and explaining what happened. It looks like your lesion has become more pronounced after your previous treatment, which can sometimes happen with cryomodulation or other superficial procedures.

For a raised, pigmented lesion like this (likely a seborrheic keratosis that didn’t respond well), there are several removal options, each with pros and cons:

CO₂ laser or ablative laser resurfacing:

Very precise and effective for raised lesions.

Can remove both pigment and texture irregularities in one treatment.

Healing takes a little longer (a few days to a week), and there may be temporary redness.

Electrodessication and curettage (ED&C):

Good for raised seborrheic keratoses.

Involves scraping the lesion and using electrical current to control bleeding and destroy remaining tissue.

Healing is typically quick, but there may be minor scarring or pigment change, especially on darker skin tones.

Liquid nitrogen (cryotherapy):

Often less ideal at this stage, since your lesion worsened after a similar approach.

Works best for smaller, flat lesions. Repeat treatments may be needed and pigment changes are common.

Given the size (10mm) and the fact it worsened after prior treatment, laser ablation or ED&C are usually more reliable to get a smooth, even result. The choice often depends on your skin type, healing preferences, and whether pigment or texture correction is the priority.

I understand how frustrating it can feel when a lesion worsens after treatment. These approaches can help restore a more uniform appearance and minimize further pigment issues.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Best method to remove a 10mm raised pigmented lesion? (Photo)

Answers (2)

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