A mole, known medically as a melanocytic nevus, is a common growth on the skin formed by clusters of pigment-producing cells called melanocytes. While the physical removal of almost any mole is possible, the decision to remove one involves a careful assessment of its nature and location. This determination balances a patient’s cosmetic wishes against the medical need for a biopsy.
Medical Necessity Versus Cosmetic Choice
The primary reason a dermatologist recommends mole removal is to rule out or treat skin cancer, particularly melanoma. Most moles are benign, but changes in appearance can signal a problem requiring immediate attention, assessed using the ABCDE criteria.
Asymmetry means one half of the mole does not match the other half when divided down the middle. Border irregularity involves edges that are notched, scalloped, or poorly defined, contrasting with the smooth edges of a typical benign mole. Color variation occurs when the mole displays multiple shades of brown, black, red, white, or blue within the same lesion.
Diameter (D) refers to moles larger than six millimeters, roughly the size of a pencil eraser. Evolving (E) is the most significant criterion, denoting any change in the mole’s size, shape, color, or elevation over time.
Any mole meeting one or more of these criteria will be removed for a biopsy, where the tissue is analyzed microscopically. Medical necessity always overrides cosmetic considerations when choosing the most effective removal method. Even if a mole is benign, a person may still choose to have it removed if it is frequently irritated by clothing or bothersome for aesthetic reasons.
Standard Techniques for Mole Removal
The method chosen for mole removal depends on whether the lesion is suspected of being cancerous or if it is purely a cosmetic concern. The two most common techniques are surgical excision and shave excision, both performed in an outpatient setting using local anesthesia.
Surgical excision involves cutting out the entire mole, along with a small, surrounding margin of healthy tissue. This deeper procedure is required for any mole that is flat, deeply rooted, or suspected of being malignant, as it ensures all melanocytes are removed. The resulting wound requires closure with sutures.
This method is the gold standard for suspicious lesions because it provides the pathologist with a complete sample for the most accurate diagnosis. Although it results in a linear scar, surgical excision offers the lowest risk of the mole growing back.
Shave excision is reserved for moles that are raised above the skin surface and clinically determined to be benign. During this procedure, the provider uses a specialized scalpel to shave the mole flush with the surrounding skin. This technique is more superficial and does not require stitches.
Shave removal results in a quicker recovery time and a less noticeable initial mark. However, because the deeper “roots” of the mole are not entirely removed, there is a higher chance of recurrence compared to full surgical excision. Other methods like cryotherapy or laser ablation are not used for definitive mole removal because they destroy the tissue, preventing proper diagnostic analysis.
Managing Scarring and Recurrence
Any procedure that disrupts the skin’s surface will result in some form of scar tissue formation. The appearance of the final scar is influenced by the removal technique, the mole’s original size and depth, and the patient’s individual skin healing characteristics. Proper wound care is important to minimize the visibility of the resulting mark.
Wounds from surgical excision, which are closed with stitches, must be kept clean and protected from tension or stretching. For both excision and shave sites, keeping the area moist with an ointment helps accelerate the healing process by preventing the formation of a thick, dry scab.
Scars from a surgical excision are linear, and while they may appear red and raised initially, they fade and flatten over a period of months to a year. Shave excision sites heal more like an abrasion, forming a flat pink patch that gradually blends with the skin’s natural tone. Protecting the healing area from sun exposure is necessary, as UV light can cause the new scar tissue to darken permanently.
Mole recurrence is a possibility, particularly after a superficial shave removal. If a mole is not completely removed, residual melanocytes can regrow, causing the lesion to reappear in the scar tissue. If a mole returns, especially after a shave procedure, a full surgical excision is recommended to ensure complete removal.