Warts are common, non-cancerous skin growths caused by infection with the human papillomavirus (HPV). While many warts respond to over-the-counter treatments, some are resistant and require professional medical intervention. Surgical and other invasive methods are typically reserved for persistent, large, or deeply rooted lesions that have not cleared with less aggressive therapies. This approach focuses on physically removing the infected tissue for a complete resolution.
Criteria for Choosing Surgical Removal
A medical provider considers several factors before recommending a surgical or invasive procedure over topical applications or cryotherapy. The primary indication for surgical removal is the failure of a wart to respond to multiple prior, less invasive treatments. This includes warts that have recurred quickly or have resisted standard acid treatments or freezing.
Wart size and depth are significant considerations, especially with plantar warts that grow deep into the weight-bearing tissue of the foot. When a wart causes pain, affects normal function, or is located in a sensitive area, surgical removal may be preferred to provide rapid relief. Excision is also performed when the diagnosis is uncertain, allowing the tissue to be sent for biopsy to rule out malignancy.
Detailed Surgical and Invasive Techniques
One direct method is surgical excision, which involves using a scalpel to cut the entire wart out of the skin. This technique is favored for deeply penetrating warts or when the tissue needs to be removed for pathological examination. The resulting wound is closed with sutures, providing the highest success rate for complete removal, though it carries a greater risk of scarring.
Another common approach is curettage and electrocautery, which combines two actions to destroy the lesion. Curettage uses a spoon-shaped instrument to scrape the wart tissue away from the surrounding healthy skin. Following this scraping, electrocautery is applied to the base of the wound, using an electrical current to burn any remaining virus-infected cells and stop bleeding.
Laser ablation utilizes focused light energy, such as a carbon dioxide or pulsed-dye laser, to vaporize the wart tissue. The laser precisely targets the moisture within the cells, destroying the wart layer by layer. This method is effective for stubborn warts and is useful in areas where scalpel excision might be challenging, such as around the nail bed.
The Patient Procedure Experience
The surgical removal of a wart is typically performed as an outpatient procedure in a clinic or doctor’s office. Before the procedure, the area is cleaned with an antiseptic solution to minimize infection risk. A local anesthetic, usually an injection of lidocaine, is administered directly into the skin surrounding the wart for patient comfort.
While the anesthetic injection may cause a brief sting or burning sensation, the patient should feel no pain during the actual removal. Patients commonly report a feeling of pressure or pulling as the surgeon works on the tissue. The entire intervention, regardless of the technique chosen, is generally quick, often taking less than 30 minutes.
Once the wart is removed and any necessary cauterization or suturing is complete, a sterile dressing is applied to the wound. Medical staff provide instructions regarding wound care and pain management before the patient is discharged. Patients can usually resume most normal activities shortly after leaving, though strenuous activity may be restricted.
Post-Procedure Care and Healing
Proper post-procedure care is necessary for minimizing scarring and preventing infection after surgical wart removal. Patients are instructed to keep the treated area clean and dry for the initial 24 to 48 hours to allow for clotting. After this period, the wound should be gently washed daily with mild soap and water, then patted dry.
Healing time varies depending on the size and depth of the wart removed, but most wounds heal within two to four weeks. If sutures were used, they will either be dissolvable or require removal by the provider after 10 to 14 days. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, are usually sufficient to manage the mild tenderness expected as the anesthetic wears off.
Patients must monitor the site for signs of complications, including excessive redness, swelling, warmth, or a thick, yellowish discharge, which indicates an infection. While the goal of surgical removal is complete eradication, recurrence is possible because the human papillomavirus can remain dormant in the surrounding skin. Any new growth or persistent discomfort should be reported to the healthcare provider.