A mole is a common skin growth composed of melanocytes, the cells that produce pigment. Dermatologists are the medical specialists who evaluate and remove these growths. Removal may be performed for a medical reason, such as concern for skin cancer, or for purely aesthetic purposes if the mole is benign but bothersome. The technique used for removal is determined only after a thorough examination of the mole’s characteristics and location.
Initial Evaluation and Screening
The dermatologist’s first action is to determine if the mole requires medically necessary removal or if the procedure is purely cosmetic. This distinction is important because medically necessary removal, typically due to suspicion of malignancy, dictates a different procedural approach. The primary tool for assessing risk is the ABCDE criteria, which guides the examination for signs of potential melanoma.
The ABCDE criteria includes:
- Asymmetry
- Border irregularity
- Color variation
- Diameter larger than 6 millimeters
- Evolving (any change in size, shape, or texture over time)
A mole exhibiting one or more of these features is considered suspicious and warrants further investigation. The dermatologist often uses a handheld magnification device called a dermatoscope to examine the mole’s deeper structure and pigment patterns before deciding on a course of action.
If the mole appears suspicious during the visual and dermoscopic examination, a biopsy is recommended to analyze the tissue under a microscope. This process involves removing part or all of the mole to send to a pathology lab for testing. The final laboratory analysis determines whether the mole is benign, atypical, or malignant, guiding subsequent treatment decisions.
Common Mole Removal Techniques
The choice of removal technique depends on the mole’s nature, depth, and the need for a biopsy. All surgical removals are performed under local anesthesia, which numbs the area to prevent pain during the procedure. The two most common surgical methods are shave removal and surgical excision.
Shave removal is reserved for raised moles that appear benign or for diagnostic biopsies of small, superficial lesions. The mole is shaved off flush with the surrounding skin using a blade. This technique is faster, requires no stitches, and leaves a minimal scar. However, the mole could regrow if pigment cells remain deeper in the skin.
Surgical excision involves cutting out the entire mole and a small margin of surrounding healthy tissue, requiring sutures to close the resulting wound. This method is required for any mole suspected of being malignant, as it ensures the deepest layers are removed for a complete pathological assessment and clear margins. Excision is also used for flat moles that cannot be shaved or for moles where recurrence is highly undesirable.
A third method, the punch biopsy, is a small, circular excision that removes a full-thickness core of tissue. It is used for small, deeper moles or to obtain a representative sample for a suspicious lesion. The size of the punch determines if the resulting hole is closed with a single stitch or left to heal on its own.
Recovery and Follow-Up Care
Immediate care for the wound involves keeping the area clean and dressed according to the dermatologist’s instructions to prevent infection. Recovery time varies; shave excisions often heal within 5 to 10 days, while surgical excisions requiring stitches may take 1 to 2 weeks for the initial closure. Proper wound care is important in minimizing the final appearance of the scar, which is an expected outcome of any procedure that cuts the skin.
For any mole that was excised or biopsied, the tissue sample is processed and analyzed by a dermatopathologist, with results typically available within 5 to 10 business days. The pathology report specifies the mole’s diagnosis and the status of the margins, which indicates whether the entire lesion was removed. Clear margins mean no abnormal cells were found at the edges of the removed tissue.
If the report indicates a benign result with clear margins, no further treatment is usually needed, and the patient returns to routine skin surveillance. A finding of atypical or malignant cells necessitates a follow-up appointment to discuss further treatment. This may include a wider excision to ensure all abnormal cells are removed.