Dr Paula Carmichael

Wellness & Aesthetics




We provide cryotherapy (liquid nitrogen treatment) for minor, superficial non-cancerous skin lesions. These include warts (plantar (feet), palmar (hands), and genital), actinic keratoses (pre-cancers), seborrheic keratoses, and skin tags. Some lesions treated are covered by New Brunswick Medicare, while others will require out of pocket payment. Your primary care provider can refer you to our office for assessment and treatment, but we will also accept self referrals.

Liquid nitrogen is extremely cold - it measures approximately -196 degrees Celcius. By applying this to the skin, we burn through the top layers of skin in an attempt to get to the base of the lesion in question. Sometimes this takes only one treatment; other times, multiple treatments. There is some discomfort associated with liquid nitrogen, but this is usually quite short lived, and doesn’t require any specific treatment. Depending on where the lesion is, you may be left with a small, pink, circular scar on the skin. This usually fades with time.


Suspicious skin lesions should always be biopsied for diagnosis. Dr. Carmichael performs punch biopsies of the skin which are sent to the local hospital lab for pathological assessment. Further treatment is determined from the results of the biopsy.

A punch biopsy is done in a sterile environment. The skin is cleaned with rubbing alcohol, then injected with local anaesthetic (freezing). Once the skin is frozen, it is properly prepped for minor surgery. A special instrument (called a skin punch) is used to remove the lesion, or piece of the lesion. This comes out in a circular form, and the tissue is placed in formalin and sent to the lab. The skin is then closed with 2-3 small sutures (depending on the size of the punch, which ranges from 2-8 mm), and a waterproof dressing is applied. We will then have you return to the office in 7-14 days (depending on the location of the biopsy) for suture removal. The result is a small linear scar.

Lesion Removal

Sometimes we have lesions on the surface of our skin that we find bothersome. These may be unsightly or uncomfortable, but are not cancerous. There are various ways that these lesions can be removed. Depending on the location, Dr. Carmichael performs both shave and excisional lesion removals. If the removal is for cosmetic purposes, it is not covered by New Brunswick Medicare.

Shave biopsies involve removal of a lesion that sits on the surface of the skin. This method can be used to remove skin tags and seborrheic keratoses. The skin is prepped and frozen, and the lesion is shaved off the surface. The area is then treated with silver nitrate, a compound that cauterizes the tissue to stop the bleeding. A dressing is applied, and the skin will heal up by forming a scab.

An excisional biopsy, or lesion removal, is used for larger lesions or lesions that extend to the deeper layers of the skin. The skin is prepared like a punch biopsy, but the lesion is then cut out using a surgical blade. The resulting defect is then closed with sutures, and a dressing applied. You will return to the office in 7-14 days for suture removal. The result is a longer linear scar, the length of which depends on the size of the lesion removed.