Removal of skin tags: scissor excision versus non-ablative 532nm-LBO-laser in a randomized intraindividual controlled observer-blinded clinical trial : Laser is not always better.

Summary

In a randomized intraindividual, observer-blinded trial of 68 patients (1,257 lesions), scissor snip excision achieved higher complete healing at 12 weeks (85% vs 71%), lower pain, and greater patient preference than a non-ablative 532 nm LBO laser. Although laser treatment was faster and bloodless, it had more erythema and pigmentary changes, supporting scissor excision as first-line therapy for skin tags.

Key Findings

• Complete healing at 12 weeks: 85% (scissor) vs 71% (532 nm LBO laser), p=0.00001
• Lower pain scores with scissor excision (mean 2.6) vs laser (mean 3.42)
• Patient preference favored scissor excision (63% vs 19% for laser; 18% indifferent)
• Laser was ~39% faster but had higher rates of erythema and hyper/hypopigmentation

Clinical Implications

Prefer scissor snip excision as first-line for pedunculated fibromas; counsel patients that lasers may be faster but carry higher risk of erythema and pigment changes and do not improve healing.

Limitations

• Single-center study with short follow-up (12 weeks)
• Limited to neck/axilla skin tags and a single non-ablative 532 nm LBO laser modality

Future Directions

Head-to-head trials with other laser modalities and longer-term outcomes (pigmentary/scar durability), cost-effectiveness analyses, and evaluation in diverse anatomical sites and skin phototypes.