4.6 Skin Growths: Skin Tags, Moles, Keratomas, and Other Benign Growths
Key Takeaways
A keratoma is an acquired, thickened patch of epidermis such as a callus, caused by pressure or friction; when it grows inward it is called a corn.
A mole (nevus) is a small, flat or raised brown spot; never wax over a mole, and use the ABCDE signs to decide when to recommend a physician check.
A skin tag is a small, soft, flesh-colored or brown outgrowth, common on the neck, eyelids, and underarms; work around it and never cut, tie off, or wax over it.
Seborrheic keratoses are benign, waxy, "stuck-on" brown growths; actinic keratoses are rough, scaly, sun-related precancerous patches that need a physician referral.
An esthetician never removes a growth; any growth that bleeds, itches, changes, or looks unusual gets a referral.
Why growths matter in a skin-care service
Benign growths are part of nearly every adult's skin. They matter to an esthetician for three reasons:
- Safety: wax, exfoliants, extraction pressure, and electrical current applied over a growth can tear, irritate, or bleed it.
- Scope: removing a growth is a medical procedure, outside what Missouri's Class E license describes, and some growths that look benign are not.
- Early detection: estheticians look at clients' skin closely and regularly, so they are often the first to notice a growth that has changed.
The growths named in the NIC outline
Keratoma (callus) and corns
- Definition: an acquired, superficial, thickened patch of epidermis caused by pressure or friction. A callus on the hands or feet is the classic example.
- Corn: a keratoma that grows inward, with a hard central core, usually on the toes.
- Esthetician action: gentle softening and exfoliation are acceptable within your training. Never cut or shave calluses. Missouri bans razor-type callus shavers, such as credo blades, in licensed establishments (20 CSR 2085-11.020(2)(L)). Painful, cracked, or infected corns go to a physician or podiatrist.
Mole (nevus)
- Definition: a small brownish spot or blemish, flat or raised, ranging from light tan to dark brown or black. Some contain hairs.
- Esthetician action:
- Do not wax over a mole, and do not abrade it with exfoliation or microdermabrasion. Mask it off or work around it.
- Hairs growing from a mole should not be tweezed or waxed without a physician's approval. Trimming them close to the surface is the safe cosmetic option.
- Use the ABCDE warning signs from Section 4.7: Asymmetry, Border irregularity, Color variation, Diameter larger than about 6 mm, and Evolving. A mole showing any of these, or one that bleeds, itches, or is new and different from the client's other moles (the "ugly duckling" sign), should prompt a recommendation to see a dermatologist.
Skin tag (acrochordon)
- Definition: a small, soft outgrowth of skin, flesh-colored to brown, often on a narrow stalk. Skin tags are common on the neck, eyelids, underarms, and groin and become more frequent with age and friction.
- Esthetician action: work around it. Apply wax so that it does not cover the tag, or protect the tag first. Never cut, tie off, freeze, or burn a skin tag. Removal is a physician procedure.
Other benign growths to recognize
| Growth | Description | Where it appears | Service considerations |
|---|---|---|---|
| Seborrheic keratosis | Benign, waxy, slightly raised "stuck-on" tan, brown, or black growth | Face, chest, back; increasingly common with age | Avoid friction and wax over it, and refer if it changes |
| Dermatosis papulosa nigra | Multiple small, dark, smooth papules | Cheeks and around the eyes, most often in deeper skin tones | Do not extract or abrade; physicians remove them if desired |
| Actinic keratosis | Rough, dry, scaly, sandpaper-like patch from sun damage; precancerous | Sun-exposed face, ears, scalp, backs of hands | Do not exfoliate it aggressively; refer, because it can progress to squamous cell carcinoma |
| Verruca (wart) | Rough or flat growth caused by HPV; contagious | Hands, face (flat warts), feet | Do not wax or exfoliate over it; refer |
| Cherry angioma | Small, bright red, dome-shaped vascular papule | Trunk, arms | Avoid extraction and electrical treatment on it |
| Lipoma | Soft, movable lump of fat under the skin | Trunk, arms, neck | Do not massage vigorously over it; refer if painful or growing |
| Xanthelasma | Soft, yellowish plaques on or near the eyelids | Upper and lower eyelids | Avoid the area; suggest a medical check, because it can be associated with high cholesterol |
| Milium | Small white keratin cyst (Section 4.3) | Around the eyes, cheeks | Do not squeeze |
Growths during specific services
| Service | Precaution |
|---|---|
| Waxing | Inspect the area first. Never wax over moles, skin tags, warts, raised growths, or broken skin. Use tweezers or trim around them. |
| Facials and exfoliation | Shield or skip growths during scrubs, enzyme or acid exfoliation, microdermabrasion, and dermaplaning. Note them on the skin-analysis chart. |
| Electrical treatments | Do not apply high frequency, galvanic, or microcurrent directly over growths or broken skin. |
| Makeup | Use single-use applicators, and avoid dragging pencils across raised growths on the eyelids. |
| Massage | Glide around raised growths; never knead or pinch them. |
Documenting and referring
- Record each notable growth on the client's skin-analysis chart by location, approximate size, color, and whether it is raised or flat.
- Compare at later visits. A growth that has grown, darkened, bled, crusted, itched, or changed shape needs attention.
- Use neutral, non-diagnostic language: "This spot looks different from the others and has changed since your last visit. I'd recommend a dermatologist take a look."
- Never reassure a client that a growth is "nothing." Only a physician can say that.
Scenario: the brow wax with a skin tag
A client books an eyebrow wax and has a small, soft skin tag just above the arch, plus a raised brown mole near the tail of the brow. The esthetician maps the shape first. Wax goes only on areas free of both growths, and the stray hairs near the skin tag and mole are trimmed or, around the skin tag, carefully tweezed. Wax is never spread over either growth. Hairs growing from the mole itself are left alone or trimmed. The esthetician notes both growths on the chart for comparison at the next appointment.
What is a keratoma?
A thickened patch of epidermis from pressure or friction, like a callus
A cancerous growth arising from melanocytes in the epidermis's basal layer
A small, soft skin outgrowth that hangs from a narrow stalk
A contagious viral growth that most often appears on the hands
During an eyebrow wax, the esthetician notices coarse hairs growing from a raised mole near the brow. What is the safest approach?
Spread hard wax over the mole, since hard wax grips only the hair itself
Lightly exfoliate the mole first so the wax releases more easily
Tweeze the hairs out of the mole, then apply an antiseptic to the area
Leave the mole alone, with no wax or tweezing, and trim the hairs if wanted
A client has a rough, dry, scaly, sandpaper-like patch on the sun-exposed top of the ear. Why is a physician referral especially important?
The patch is a callus that needs to be shaved down with a razor blade
The patch is a skin tag that will fall off after a microdermabrasion pass
The patch suggests an actinic keratosis, which can become cancer
The patch is milia that should be extracted after steaming the ear
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