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Wart or Scar Tissue
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Wart or Scar Tissue

Doctor:

I am back to seek your expertise. I have previously discussed with you a wart that was removed from my lower lip and the resulting scar left from the biopsy, about the size of a pencil eraser.

I went back to my derm. and showed him the slightly raised, white spot left behind from where he performed a biopsy (it has been about 4 months). He indicated that the spot is scar tissue. He did not believe it was the wart growing back. He indicated that if the scar area was bothering me, he could perform what I believe he called a "two box procedure", where he would cut out the scar area and use a stitch to close it. He indicated that this would leave at most a line scar, but it would not be raised as the existing spot is and would be less noticable.

I went for a second opinion to another derm. who indicated that she believed that the wart was growing back (she based this on visual inspection, where she indicated that only part of the area where the biopsy was done is raised, and it appeared to her that the wart was growing back in a spot, but the rest of the biopsy area was flat). She recommended treatment of the wart by freezing, then for me to go see a plastic surgeon for the remaining scar.

I am not sure how to proceed. I have scheduled to see a plastic surgeon to discuss the scar and opportunities to remove/reduce it. As you can tell, it is something that bothers me and I would like to make it go away.

What would you recommend I do?

1) I am concerned that my derm. who has now indicated he can cut out the scar and make it less noticable is the same one who created the scar by performing the biopsy and not making efforts (like stitches) to keep me from scarring in the first place. Do you think that his plan of action will result in the removal/reduction of the scar?

2) Would you recommend that a plastic surgeon does the scar removal instead of the derm.? Is the "two box" a common procedure that will work?

3) How should I resolve the discrepancy in opinions between the derms? (wart is growing back or scar tisue)

4) What should I expect if the wart is treated by freezing? What will it look like and how long will it look that way?

5) Does freezing run the risk of scaring more?

Thanks, as always for the expertise. You have been a great resource.
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I think you should have the plastic surgeon take out the scar.  That will get rid of any wart even if there is one.  I doubt there is, since looking (as the second derm did) can be misleading, and your description sounds like scar, not wart.  Freezing is safe, but I don't see it giving you any added benefit, since you'll need surgery anyway.

I don't know what a two-box procedure is, but I'm not very surgical.  Although some dermatologists are quite adept surgically, when it comes to cutting on the face, I'd want a plastic surgeon to do it if it were my face.

Good luck.  I think you'll do well, and end up with a much less noticeable scar.

Dr. Rockoff
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