Every day I spend much of my time looking at patients' moles. The most important reason I look at moles is to try and detect melanoma at its earliest stages. When melanoma is detected early, survival rate is nearly 100%. Because it is often diagnosed too late, around 8,000 people die of melanoma in our country each year. For this reason, I have spent countless hours working to improve my ability to evaluate moles and determine which ones need a biopsy and which ones can be left alone. This is a skill I will work on until the day I retire because my ability to make the right decision can be a matter of life or death.
Fortunately, I'd say 99% of the moles I look at day to day are not concerning for cancer and do not require removal. One of my favorite things about being a dermatologist is being able to provide comfort and assurance to my patients who are convinced they have cancer. Informing them their mole is benign and doesn't even need a biopsy often brings them great joy. Most of the time, patients just want to know their moles are benign, but several times a day I get asked about removal of benign moles.
Reasons to Remove a Mole
As alluded to above, the main reason to remove a mole is to make sure a patient does not have melanoma. After a mole is removed via a skin biopsy, it is sent to a pathologist who specializes in looking at moles under a microscope. Because you can't always tell just by looking at a mole if it is cancerous, moles removed from a patient are almost always sent for examination by a pathologist.
If after looking at a mole I do not have any concern for cancer, there are still two other main scenarios for mole removal. The first scenario is for moles that protrude from the skin and get caught on clothes, jewelry, or other items which leads to pain, discomfort, or even bleeding. These types of moles are most common on the neck, back, scalp, or other areas prone to trauma.
The other scenario for removal is primarily for cosmetic reasons. While some moles can rightfully be considered a "beauty mark", many patients aren't so lucky and have moles that detract from their overall appearance. When this is the case, I begin the sometimes lengthy process of helping a patient decide if removing their mole is right for them.
How are Moles Removed?
Contrary to what many patients believe, moles are rarely burned off or removed by laser. This is because, as was mentioned above, any mole removed by a dermatologist is sent to be evaluated by a pathologist to ensure there are no signs of melanoma within the mole. Without surgical removal, evaluation by a pathologist is not possible.
To surgically remove a mole, there are two main techniques. The most common method is by doing a shave removal. For this procedure, the area is numbed with lidocaine and a thin, flexible blade is used to essentially scoop the mole out of the skin. This method has the advantage of being quick and does not require any stitches. Since the wound is shallow, it heals quickly in most locations.
The second method for removal is called a surgical excision. For this type of removal, the area is numbed and the mole plus a thin layer of normal skin around the mole is remove with a scalpel blade cutting down to the fat. The excision is usually done in the shape of a football which allows the skin to be closed with stitches without creating any puckers at the ends. Depending on the location, the stitches are removed in about 7-14 days.
Will Removing My Mole Leave a Scar?
Unfortunately in almost all instances, surgical removal of a mole will leave a scar. Certain areas of the body heal better than others, so in some locations, scarring can be nearly imperceptible. Also, scars located within a wrinkle line such as the line between the edge of the nose and corner of the mouth (nasolabial fold) allow the surgeon to hide the scar line within the fold. In this scenario, the scar can be nearly impossible to see. When moles are on areas such as the nose or in the middle of the cheek, scars can be very difficult to hide.
When I inform a patient that removing their mole will leave a scar, patients often ask if they can go to a plastic surgeon. While I have the utmost respect for my colleagues in Plastic Surgery, they do not have the ability to surgically remove moles without a scar. Both Plastic Surgeons and Dermatologists use the same techniques to remove moles, and often Dermatologists have even more experience in performing surgery in areas such as the face, so referral to a Plastic Surgeon typically will not lead to better outcomes.
How Will I Decide if I Should Remove My Mole or Not?
Deciding if you should remove a mole for cosmetic reasons can be a very difficult decision. My wife has hundreds of moles, and even though I can remove them at no cost to her, I have biopsied very few of them over the years. This is because, in many instances, removing the mole will lead to a scar that looks as bad or worse than the mole no matter how the mole is removed.
Moles that are raised and have a sharp border such as the one pictured below usually do quite well with a shave removal. Although they will leave a scar, the scar is usually much less noticeable than the original mole.
Flatter moles such as the one pictured below are a different story. For a shave removal, the mole must be scooped out of the skin. In some locations, that can leave a depressed scar which is often much more noticeable than the original mole. For these types of moles, a surgical excision is often preferred. Depending on the location, the linear scar that results may or may not be more cosmetically appealing than the original mole.
What Happens if I Don't Like My Scar?
If your scar is less than ideal, there are several methods available to improve the appearance. Procedures such as chemical peels, microneedling, or even laser resurfacing can be used to improve the appearance. In other cases, injections with saline or dermal fillers can be done to help elevate scars that are depressed, or steroid can be injected into scars that are raised. In some instances, doing a larger excision might be the next step, especially for moles that were originally removed with a shave removal. These and several other methods can be used to improve the appearance of a scar to the point where it is barely noticeable.
Helping You Decide
While I wish I could tell every patient that removing their moles and other skin growths would definitely lead to an improved cosmetic appearance, sadly this isn't always the case. Admittedly I tend to take a more conservative approach and encourage patients to leave moles alone that aren't easily removed unless they are very noticeable and detract from the overall appearance of the patient.
If you have any moles or other spots on your skin that bother you or give you concern, don't hesitate to come in for an evaluation. With me, you will at least get an honest assessment of the pros and cons of any procedure. My goal is to help you decide what will give you the best long term outcome to help insure you will be happy with the results.
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