A preauricular skin tag, also called an accessory tragus, is a common “extra” part to the ear that is present at birth and, if left alone, continues to grow as a child grows. Embryologically speaking ears are extremely complex things, and it’s not uncommon that occasionally there are small extra nubbins of tissue that develop as the ears form. These small nubbins contain skin, fat and cartilage.
what is the process?
The image below outlines the process of consultation, procedure and follow up under our COVIDsafe approach, which uses videoconsultation where appropriate.
How is the extra tissue removed?
Removal of the extra tissue can be performed easily under local anaesthetic as a rooms procedure when a child is in the first three months of life.
What does the procedure involve?
We arrange a time for you and your child to attend the rooms for the procedure. On arrival at our practice a member of our staff will apply local anaesthetic cream to the area and a clear adhesive covering. This local anaesthetic numbs the skin.
On your arrival at our rooms we encourage you to feed your baby as in our experience this increases the likelihood that they will sleep through the procedure.
During the procedure your baby is placed on his or her side in a comfortable foam pillow that is specifically designed to securely support your baby. We remove the clear adhesive covering and wipe away the local anaesthetic cream. A small amount of local anaesthetic is injected at the base of the skin tag with a tiny needle, ensuring that your baby will feel no discomfort from the procedure.
Dr Tomlinson and a registered nurse are with your baby at all times during the procedure. You are welcome to stay for the procedure, and we find that most parents prefer this, but you are also welcome to wait in another room or to step outside briefly for fresh air.
The extra tissue is surgically removed and the area is stitched with tiny absorbable sutures – usually two are used. We cover these stitches with a small steristrip and apply surgical glue over the top so that you do not have to do anything special with the dressings. Your baby can be bathed as normal after the procedure, and the dressings and stitches will lift off when they are ready.
We always send the tissue for pathology testing.
What follow up is required?
We routinely schedule a follow up telehealth appointment for you and your baby at 1-2 weeks after the procedure to check that everything is progressing satisfactorily. If this visit is difficult for you to attend or you prefer to send us a photo and email update we can offer feedback by this method if all is progressing as planned. If things are not progressing as planned or you have any concerns it is our strong preference that we see you to assess what is happening and provide you with advice and assistance.
What is the best age for treatment?
We schedule the procedure prior to three months of age - the earlier the better. After three months of age the procedure is more difficult because your baby is more aware of its surroundings. Older babies are less likely to sleep through the procedure and more likely to move their heads or arms during the procedure. They are more likely to need to be physically restrained as the procedure is performed, which can be more distressing for the infant and for its parents. Therefore, we only perform the procedure in rooms under local anaesthetic where babies are less than three months of age.
Older babies cannot be relied upon to “hold still” for a rooms procedure so we recommend that they have a general anaesthetic and that this be performed when they are at least two years of age. For this reason we advocate early treatment as it is simpler and easier for all involved, with fewer risks.
Are there any associated long term problems?
No, there are no long term problems associated with this condition or with surgical removal of the tissue.
What does the area look like after removal?
The following photographs show a typical patient with two skin tags for removal. The first photograph shows the area on the day of the procedure, after the local anaesthetic cream has been wiped away:
This second photograph shows the area with surgical marking texta marking the base of the two skin tags. Dr Tomlinson marks the site with surgical marker prior to administering the local anaesthetic fluid, as the fluid can cause swelling which alters the appearance of the area, making the exact area of extra tissue more difficult to determine. This marking also allows parents to confirm the areas that are planned for removal.
The third photograph shows the site after removal of the excess tissue. There are dissolving stitches at the site where the extra tissue was removed, and the shine on the skin surface is from the multiple layers of surgical glue that have been applied. The appearance of some remaining purple from the surgical marker is normal and temporary, as is the (very small) amount of red colour (blood) visible at the site of the lower excision. The pale discolouration of the skin in the treatment area is temporary and results from the local anaesthetic mixture.
How do I arrange a consultation with Dr Tomlinson?