Yesterday at a shopping mall, I saw a product that can be used to topically remove skin tags. It offers to easily remove them at your convenience. As a Denver skin cancer specialist especially in the eyelid and face area, I commonly see patients who have eyelid growths that end up being skin cancers. Though I am a huge fan of herbal medicines and use them for cosmetic surgery (arnica Montana and bromelain) I think that this herbal treatment of “skin tags” is dangerous and a terrible idea. Why is this?

There are four types of skin cancers that primarily affect the eyelid: basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma and melanoma.

The first two cancers can be removed and often do not spread or metastasize to other parts of the body such as the lymph nodes or liver. Sebaceous cell carcinoma often looks like a chalazion but can spread to the lymph nodes, liver and brain. Melanoma of the eyelid is very serious and can kill you. I have had several patients who have not survived melanoma of the eyelid after ignoring it for some time. There are also a lot of benign growths on the eyelids such as skin tags or achrocordons. These can be easily removed. So how does one differentiate between a skin tag and a skin cancer? Obviously, burning off the surface of skin cancer and leaving cancer cells on the eyelid is dangerous if not silly. It could result in a much bigger growth once it comes back.

There are several characteristics of skin cancer growths such as abnormal color, irregular growth, loss of architecture, spontaneous bleeding, eyelash loss that skin tages normally do not have. Using those criteria, oculoplastic surgeons or myself in my office in Denver evaluate lesions and try to guide patients to the best management. If I remove the lesion I will always send it to pathology for analysis under the microscope. Why is that?

A study by Kersten looked at how often oculoplastic surgeons can predict whether a lesion is cancerous or not cancerous by just looking at it. These are surgeons who have gone to medical school, then trained in microscopic analysis of lesions and the eye during an ophthalmology residency for four years and then completed a two year fellowship training in eyelid, tear duct, facial surgery and eye socket surgery. Well you would think we would be right 100% of the time or close to it. In fact, we are correct 98% of the time. Sounds pretty good right? Well if I remove 6 lesions a day for 20 days in a month, that means every month two or three lesions that I thought were not cancerous are actually cancer. If I did not biopsy those patients when I removed them in a year there would be roughly 25 patients who had eyelid cancer and are not properly being treated.

Use this information to apply to lay patients looking at their own eyelid growths. Would they be easily able to differentiate a skin tag from an eyelid cancer? I don’t think so. Considering the subtle differences between the two, it would make sense that a biopsy would be in order to make sure. However, when using a home remedy that is not possible.

I encourage all patients who have an eyelid growth to see an oculoplastic surgeon who has a deep understanding of eyelid lesions and growths. Denver and Colorado has a high incidence of eyelid cancers because of the high sun exposure. It is not worth taking a chance and leaving cancer inside your eyelid or face because of convenience. Hopefully this helps patients who have eyelid growths on their face and were thinking of using this product.