Common Procedures

Warts || Moles and Lesions || Ingrown Toenails || Tongue Tied (Ankyloglossia) || Molluscum || Billing Information

At Alpine Pediatrics we perform a number of procedures. Listed below are some of them along with their treatment options, risks, outcomes, and alternative resources.


Warts are caused by the human papilloma virus (HPV). About half of the various strains of HPV will cause different types of warts that we see in children. A child's immune system will eventually make the correct antibodies to get rid of the virus, though it can take years and warts may spread to other areas during this time.

Wart Treatment
Although warts are unsightly, they typically do not need to be treated, and waiting for warts to disappear on their own is an acceptable approach. The variety of over-the-counter (OTC) treatments and home remedies for warts are about 50% effective. The two treatments we offer in our office are slightly more effective, but despite our best efforts even warts removed professionally can return and even spread. Infection is a risk with any procedure that damages the skin, so it's very important to keep the wound clean and follow all wound care instructions.

Cryosurgery (Freezing)
In cryosurgery, the wart is frozen with liquid nitrogen. This produces a blister on and around the wart that will eventually slough off and heal, similar to a blister from a burn. Normal healing time is about 3 weeks. The affected skin is usually discolored as it heals, and it can also leave permanent scarring.

Electrocautery (Burning)
An electrodessicator, often referred to as a Bovie, destroys a lesion or wart by passing an electrical current to it. The lesion or wart associated tissue is then removed. This more invasive technique leaves a hole in the skin that scabs over and eventually scars. This method is typically reserved for plantar type warts or warts that are unresponsive to other treatments.

Candida Extract (Blistering Agent)
Candida extract is injected into the wart. Most patients feel a burning sensation that can last a few minutes to a couple of hours. Redness of the area afterwards is not unusual. The wart then goes away over 2-3 weeks. The skin may peel or be a bit sensitive at this point, but open sores are uncommon. Occasionally, a second treatment is required and it is recommended to be completed approximately 3-4 weeks after the first treatment. Local reactions include burning, blistering, and peeling.

Wart Referral
At times warts become too invasive, so we refer to a specialist, such as a dermatologist or podiatrist. These specialists have additional treatment options, including laser removal and immunotherapy. We will discuss these options at your visit.

The cost to remove up to 14 warts is $220.

Moles and Lesions

Most moles and lesions are not cancerous in children; however, some will show unusual microscopic changes that can potentially develop into a precancerous lesion. We will evaluate each mole or lesion and discuss the possible treatment options and referrals. Some moles and lesions will require removal due to cosmetic reasons or irritation due to location.

Mole Treatment
A mole or lesion can be either removed entirely or a by biopsy (small sample) can be taken and sent to a pathologist in a lab. If the biopsy reveals any abnormal growth, the mole should then be completely removed. Removal typically involves cutting the mole out and then stitching the skin closed. Although we take great care in this process, there is always a risk of infection and scarring. Basic wound care instructions are to keep the area clean and dry, but this may vary depending on the location of the wound. Due to the size or location, some moles and lesions should be referred to a specialist, like a dermatologist or plastic surgeon.

Depending on the location and size, the cost ot remove a mole is up to $600.

Ingrown Toenails

Ingrown toenails are a common problem in pediatrics. They are typically caused by trimming the nails too short or incorrectly, and trauma can also cause the nail to grow abnormally.

An infected toe may be treated with antibiotics, or in more severe cases a small portion of the nail may need to be removed. THe toe is anesthetized for this procedure and then bandaged. Careful hygiene and care for the toe is essential to promote the toe's healing. After nail removal, the toe should be soaked in warm Epsom salt water and the dressing should be changed daily. This will improve the discomfort from the ingrown nail. Regrowth of the extracted portion will take anywhere form 6-9 months. If your child suffers chronically from ingrown nails, it may be necessary to refer to a podiatrist for more definitive treatment.

The cost to remove an ingrown toenail may be up to $310.

Tongue Tied (Ankyloglossia)

The majority of infants with tongue-tie are able to breastfeed without difficulty; however, breastfeeding problems such as poor latch and maternal nipple pain are reported more frequently. Consultation with a lactation consultant after mother's milk supply is established is recommended to exclude other causes of breastfeeding difficulty.

Frenotomy (Tongue Clipping)
For infants with tongue-tie who continue to have problems breast-feeding despite lactation support, clipping the tongue-tie may help. In some cases, however, breastfeeding difficulties persist despite clipping. Potential adverse effects include bleeding, infection, ulceration, damage to the tongue and submandibular ducts, adn recurrence, although these complications are extremely rare.

The cost of a tongue clip is $425.


Mulluscom are caused by poxvirus and causes skin growths, often called "water warts", that can spread locally and person to person. The lesions often are skin colored to a bit pink, smooth topped with a small dimple in the center. They are harmless and painless but may need treatment if your child picks at them, are in areas of friction (for example, the armpit), are spreading quickly, or you feel they are a cosmetic problem.

Molluscum Treatment
Cantharidin is an extract of the bombardier beetle, as well as other blistering insects (wasps, etc). It is painless when applied, but leads to blistering that can help clear molluscum. We typically do not treat more than 5 lesions at a time. If your child has more than this, then future visits for treatment will be indicated.

Billing Information

Your insurance does not include these treatments as part of a standard well-child visit. We must bill them separately based on a code that is specific to the procedure. Billing is not based on effectiveness of treatment. If you return for a repeat treatment or choose to be seen by a specialist, you should plan to be billed for a separate service.