See below for-

Minor surgery

We are able to carry out some minor surgical procedures in the practice. This avoids the need for you to attend hospital and is usually much quicker. All procedures are carried out by an experienced GP, who may be assisted by a nurse.

The procedures we are able to do include:

• Freezing and removal of warts (not genital warts).
• Removal of small skin non cosmetic  "lumps and bumps", e.g. moles, skin tags and cysts.
• Injection of joints, e.g. steroid injections for arthritis.
• Draining of excess fluid, e.g. from joints and cysts.
• Nasal cautery, to stop frequent nose bleeds.

How to arrange a procedure

1. Please book an assessment appointment in normal surgery or phone us. These appointments can be booked at reception as usual.
2. If your problem is suitable for in-house minor surgery then you will be booked a further appointment for the procedure. If your problem is not suitable for in-house minor surgery then the GP may refer you to the hospital.

It lives where most life does not... enduring and proliferating. It wreaks havoc in the cracks and crevasses of the skin and other mucous membranes, often causing discomfort and cosmetic embarrassment.

As obdurate and unsightly as its name, Verruca vulgaris, the common wart inconveniently finds temporary niches on thousands of people, many of whom avoid revealing its unwelcome existence.

For most people, especially children and teenagers, revealing that a wart has invaded and colonized a part of their body has often meant subjection to painful cryotherapy - the removal of warts by freezing them with liquid nitrogen.

Mandy Redig, a JYI science journalist and student at Arizona University, remembers, (yet wishes she could forget), her wart removal experience at the age of six. Redig claims she had a sadistic doctor who scraped her two warts till they bled, then poured liquid nitrogen all over them. "I screamed and screamed. It was horrible," she says.

A less painful and invasive therapy for wart removal

Now six-year olds and the many other patients who are afflicted with the common wart, caused by human papillomaviruses, can be spared nightmarish experiences like Redig's. Researchers at the Madigan Army Medical Center in Tacoma, Wash., have discovered a less painful and invasive therapy for wart removal.

Neither abrasive liquid chemicals that attack chemically sensitive nociceptors, (pain receptors embedded the skin). As reported in the October 2002 issue of the Archives of Pediatrics & Adolescent Medicine, all that is needed to remove the common wart are a few pieces of household duct tape, a small pumice stone, and one to two months of patience.

Who would have thought that duct tape, invented during WWII by Johnson & Johnson to keep moisture out of ammunition cases, would one day be used to therapeutically remove the common wart? Already one of the most versatile tools in the household, duct tape can now add wart removal to its ever-expanding résumé.

Dr. Dean R. Focht III of the Cincinnati Children's Hospital Medical Center and principal researcher for the study says duct tape irritated the warts, apparently causing an immune system reaction that attacked the growths.

Three-ply construction

The effectiveness of duct tape could possibly stem from its three-ply construction. The Great Fact Finder website shows that duct tape is composed of three layers. The top layer is a resilient plastic (polyethylene). The bottom layer is a rubber-based adhesive, and in between is a layer of fabric mesh. Yet whether it is the actual composition of the tape or its mere application to the wart, the use of duct tape, (termed duct tape occlusion therapy) has a higher success rate for wart removal than cryotherapy. In Focht's study, 85% patients ranging from 3 to 22 years of age who underwent duct tape occlusion therapy had complete "resolution of the warts," compared to only 60% patients undergoing cryotherapy. With such a high success rate, unaccompanied by burning, itching, and sometimes indescribable pain, duct tape would seem to have a promising future as the preferred method of treatment to remove the common wart.

Occlusion therapy
My sister Christina DeMichele, a recent Boston College graduate, would never have undergone cryotherapy if she'd known that duct tape occlusion therapy existed. The liquid nitrogen applied to the warts on her knee first caused blisters two to three times the size of the wart. Then the warts turned a disgusting blackish-brownish color and throbbed. "The nights I came home from the dermatologist, I knew I was not going to get any sleep. It was impossible to ignore the pain," she says.

Now all she would have to do is apply duct tape, rub the wart-infected area with a pumice stone, and repeat until the warts disappeared. (See side bar for step-by-step instructions). Occlusion therapy may save people the time and expense of dermatologist visits, as well as avoiding a treatment that tests, if not surpasses, their tolerance for pain.

Other home remedies for the common wart

Yet, besides duct tape, other home remedies for the common wart are ubiquitous, albeit unscientifically tested. The common wart historically has had a negative connotation - often associated with witches and toads - so people have long sought methods to contain or destroy these benign, yet aesthetically unpleasing, growths.

According to the Recipe Goldmine website, a vitamin E bath with a bandage works wonders, as do crushed garlic cloves. According to Food Folklore, cutting an apple into as many pieces as there are warts, rubbing each piece on a wart and then burying it in the earth cures the affliction. As unlikely as these cures and countless others may seem, they might be worth a try. Why? Prior to the release of the Archives study and duct tape's new claim to fame, the British Journal of Medicine published in August 2002 a systematic review of folk treatments for cutaneous warts. It showed that, apart from topical treatments containing salicylic acid, there is no clear evidence that any treatments for warts are effective. In addition, the reviewers found no clear evidence that any of the medical treatments, (including cryotherapy) have higher cure rates or fewer side effects than the folk remedies.

As the Archives recent study indicates, people can simply visit their tool kit or kitchen drawer and find that reliable, gray roll of tape. Soon this super tape may adorn not only their kitchen appliances and broken ceramic dishes, but also their knees, fingers, and toes.

Cryotherapy

Cryotherapy refers to a treatment in which surface skin lesions are frozen.

Cryogens used to freeze skin lesions include:

• Liquid nitrogen (the most common method used by doctors)
• Carbon dioxide snow (more commonly used 20 years ago)
• Dimethyl ether and propane or DMEP (available over the counter as Wartner®)

Liquid nitrogen cryotherapy equipment

Swabs	Spray gun	Spray gun
Dewar flask	Dewar flask safety	Spraying viral warts

Skin lesions treated with cryotherapy

Lesions that may treated by cryotherapy include:

• Solar keratoses
• Viral warts
• Seborrhoeic keratoses (senile warts)

Doctors sometimes freeze small skin cancers such as superficial basal cell and in situ squamous cell carcinomas (Bowen's disease), but this is not always successful so careful follow-up is necessary.

Freezing may be the most suitable way of getting rid of many different kinds of surface skin lesion. It is relatively inexpensive, safe, and reliable. However, it is important that the skin lesion has been properly diagnosed. It should not be used to treat melanoma or any undiagnosed pigmented lesion that could be melanoma.

The treatment

Liquid nitrogen
Cryotherapy using liquid nitrogen (temperature –196C) involves the use of a cryospray, cryoprobe or a cotton-tipped applicator. The nitrogen is applied to the skin lesion for a few seconds, depending on the desired diameter and depth of freeze. The treatment is repeated in some cases, once thawing has completed. This is known as a ‘double freeze-thaw’ and is usually reserved for skin cancers or resistant viral warts.

Cryotherapy stings and may be painful, at the time and for a variable period afterwards. There may be immediate swelling and redness. This may be reduced by applying a topical steroid on a single occasion straight after freezing. Aspirin orally may also reduce the inflammation and discomfort.

Cryotherapy

During liquid nitrogen freeze of lesion on arm	A few minutes after cryotherapy to solar keratoses	The day after cryotherapy to solar keratoses
Clear & bloody blisters from freezing the previous day	Eyelid swelling from a freeze two days earlier	Infected cryotherapy wound from a freeze three days earlier

Looking after the treatment area

The treated area is likely to blister within a few hours. Sometimes the blister is clear and sometimes it is red or purple because of bleeding (this is harmless). Treatment near the eye may result in a puffy eyelid, especially the following morning, but the swelling settles within a few days. Within a few days a scab forms and the blister gradually dries up.

Usually no special attention is needed during the healing phase. The treated area may be gently washed once or twice daily, and should be kept clean. A dressing is optional, but is advisable if the affected area is subject to trauma or clothes rub on it.

When the blister dries to a scab, apply petroleum jelly (Vaseline) and avoid picking at it. The scab peels off after 5-10 days on the face and 3 weeks on the hand. A sore or scab may persist as long as 3 months on the lower leg because healing in this site is often slow.

Secondary infection is uncommon. When it occurs it may cause increased pain, swelling, thick yellow blister fluid, a purulent discharge and/or redness around the treated area. Consult your doctor if you are concerned: topical antiseptics and/or oral antibiotics may be necessary.

Final results

After a standard freeze of a solar keratosis, seborrhoeic keratosis or viral wart, the skin may appear entirely normal without any sign of the original skin lesion.

However, cryotherapy may result in a white mark (hypopigmentation) or a scar, particularly when freezing has been deep or prolonged, as is required for a cancerous lesion. A white mark may sometimes follow a light freeze. The white mark may be quite noticeable especially in those with darker complexions. Although the appearance often improves with time, the colour change can be permanent.

Skin lesions may fail to clear or may recur at a later date, necessitating further cryotherapy, surgery or other treatment.

A hard freeze to the skin overlying a superficial sensory nerve, such as treatment to a viral wart on the side of a finger, can cause numbness of the skin area that the nerve supplies. The feeling nearly always returns to normal within a few weeks or months.