Skin Tag Removal


Skin Tag Removal Consent Form

Equipment List

Nitrile exam gloves (1 pair)

Toothed pickup (1)

DermaBlade (1)

ChloraPrep swab 3 ml (1), or Alcohol swabs (many)

Sterile 4x4 gauze (10)

Band-Aid (as many as tags to be removed)

DrySol (Aluminum chloride) (1)

Sterile cup for DrySol (such as urine specimen cup) (1)

Sterile cotton tipped applicators (CTA) (10)

Additional Optional Equipment

If pathology and anesthesia required

1% or 2% lidocaine (with epinephrine) (1 vial with minimum 20mL remaining)

10 ml syringe (2)

18 gauge 1.5 inch needle (2)

27 gauge 1.25 inch needle (2)

Exam-room sheet (1 sheet, when necessary due to location of area to be excised)

Chux pads (3)

Formalin cups (if needed for suspicious tags to be sent for pathology)

Procedure Note


Before the procedure began the risks and benefits were discussed, including the risk of bleeding, scarring, infection, or need to repeat the procedure.  Patient voiced understanding and desire to proceed.  Timeout performed (time documented on paper form).  

Acrochodon was grasped with pickups, then thin stalk was excised flat with DermaBlade.  Per patient request no anesthetic was used.  Aluminum chloride immediately applied to area to stop bleeding, then BandAid applied.  This was repeated for _ acrochordon which the patient desired removed.  Good hemostasis.  There were no complications.  Wound care and post-procedure warning signs were discussed.  Patient voiced understanding.