Mole Removal

Mole Removal Introduction

Moles, or nevi, are frequently removed for a variety of reasons. They can be removed by two surgical methods:

• Excision (cutting), with or without stitches
• Excision with cauterization (a tool is used to burn away the mole)

Although laser excision has been tried for moles, it is not usually the method of choice for most deep moles because the laser light doesn't penetrate deeply enough.

Typically, the doctor or dermatologist (a skin specialist) may choose excision with or without stitches, depending on the depth of the mole and the type of cosmetic outcome desired.

• What is a mole?
  • Many people refer to a mole as any dark spot or irregularity in the skin. Doctors use different terms. But the following types of skin marks such as these are not treated the same way moles are and are not discussed here:
    • Birthmarks
    • Abnormal formations of blood vessels (hemangiomas)
    • Keratoses (benign or precancerous spots, which appear after about age 30 years)
• What causes moles?
  • Some people are born with moles. Other moles appear over time.
  • Sun exposure seems to play a role in the development of moles and may even play a role in the development of atypical, or dysplastic, moles.
  • The role of heredity cannot be underemphasized. Many families have a type of mole known as dysplastic (atypical), which can be associated with a higher frequency of melanoma or skin cancer.

Risks of mole removal methods vary from infection to anesthetic allergy and nerve damage. It is always prudent to choose a dermatologist or surgeon with appropriate skills and experience with these removals. This will decrease your risk associated with this procedure.

• Other risks vary depending on the area being treated and the method of removal.
• One of the most common difficulties after mole removal is a scar. Many people will attempt to remove moles for cosmetic reasons, not realizing that each and every removal may result in a scar. Many times your surgeon can give you an idea of the type and location of a scar after mole removal before you make your decision about removal.

• The area to be treated will be cleansed. Depending on the surgeon's preferences, this will be done either with alcohol, Betadine, or another suitable material.
• Then the area will be numbed with anesthetic, such as lidocaine (Anestacon, Bactine, LidaMantle, Lidocaine Viscous, Lidoderm, Medi-Quik Spray, Xylocaine Jelly, Xylocaine Topical, Xylocaine Viscous, Zilactin-L). This will not usually take much time to accomplish. Many surgeons prefer to wait after numbing to allow the blood flow to the area to diminish (sometimes up to 15 minutes).
• Depending on the size of mole and method used for excision, a sterile drape may be placed over the area to be treated.

• Removal with simple cutting without stitches
  • The surgeon takes a scalpel and shaves the mole off flush or slightly below the level of skin.
  • Then, either an electrical instrument will cauterize or burn the area or a solution will be placed on the area to stop any bleeding.
  • After this, a topical antibiotic is placed on the wound.
  • The wound is then covered with a bandage.
  • The doctor will give you instructions on how to take care of your wound. You are usually able to leave the office shortly after.
• Removal by cutting with stitches
  • Moles removed by excision (cutting) with stitches are usually darker in color or flat moles, or both.
  • The surgeon maps out the mole and then sterilizes or cleans the area and numbs it.
  • Then a scalpel is used to cut the mole and a border surrounding the mole. The border size depends on the concern of the surgeon for the mole being removed. If there is concern that the mole could be precancerous or cancerous, a larger border will be removed to ensure that the mole itself is completely excised.
  • Depending on the depth of the mole (how deeply the mole penetrates into the skin), stitches are placed either deep (these are absorbed by the body and do not have to be removed) or on the upper surface of the skin (these don't absorb and will be removed later).

• Home care
  • After the procedure, you need to keep a layer of antibiotic salve and a bandage on the wound. Use an antibiotic ointment that does not includeneomycin (Medi-Quik, Neosporin, triple antibiotic). Many people are allergic to neomycin and may develop a rash at the site. Polysporin is a brand that does not contain neomycin.
  • Clean the wound once or twice daily with either water or diluted hydrogen peroxide.
  • After cleaning the wound, apply the antibiotic salve and bandage.
  • These steps are repeated until the wound is healed.
• Misconceptions about healing
  • Some people think that wounds need to be open to the air and that this helps healing. Several studies have disproved this and found significantly quicker healing with bandages and antibiotic salve.
  • Similarly, vitamin E has been found to slow healing rather than accelerate it, and scars were shown to be worse with vitamin E placed directly on wounds than without it.
  • There are several scar remedies on the market, including Kinerase Scar Healing Therapy, Skin Medica Scar Recovery Gel, Mederma Skin Care for Scars, Avene Cicalfate Restorative Skin Cream, Kelo-Cote Advanced Formula Scar Gel, and many others. These all have the common feature of covering a scar and providing a healing membrane during and after the initial procedure. It is unclear whether a bandage alone can provide this same effect.

Simple mole removals are frequently not followed up with an office visit, but this may vary depending on the type of mole.

• For lab results: You may receive a phone call from the doctor if there is any indication of unusual features once the tissue has been analyzed by a pathologist. Then you would see the doctor for a follow-up recheck of the area and full examination of the rest of your body.
• For stitch removal: Follow-up depends on the area that received stitches and the type of suture that was used. Facial sutures are typically removed within four to seven days. Stitches elsewhere are usually removed from eight to 21 days, depending on the type of suture and the surgeon's preference.
• To prevent infection: During the time of the recovery, you need to be careful not to get the area dirty. Also, trauma needs to be avoided to the area, including avoidance of unnecessary stress and strain to the area.

It is necessary to call the doctor if you notice any of these signs of infection:

• Excessive discharge, bleeding, or foul-smelling fluid from the wound
• Fever higher than 100 F (in an adult) or higher than 101 F (in a child)
• If pain is severe and does not go away if you take acetaminophen (Anacin-3 Maximum Strength, Childrens Tylenol, Tylenol, Tylenol Caplet, Tylenol Caplet Extra Strength, Tylenol Extended Release, Tylenol Extra Strength, Tylenol Gelcap Extra Strength, Tylenol Suspension). (Don't use aspirin [Arthritis Pain, Aspergum Cherry, Aspergum Orginal, Aspir-Low, Aspirin Lite Coat, Aspirin Low Strength, Bayer Aspirin, Bayer Aspirin Regimen, Bayer Childrens Aspirin, Bufferin, Bufferin Arthritis Strength, Easprin, Ecotrin, Empirin, Fasprin, Genacote, Halfprin, Norwich Aspirin, St. Joseph Aspirin, St. Joseph Aspirin Adult Chewable, Stanback Analgesic, Tri-Buffered Aspirin, Zorprin] or ibuprofen [Advil, Advil Childrens, Advil Junior Strength, Advil Liquigel, Advil Migraine, Childrens Ibuprofen Berry, Genpril, IBU-200, Midol IB, Midol Maximum Strength Cramp Formula, Motrin, Motrin Childrens, Motrin IB, Motrin Infant Drops, Motrin Junior Strength, Motrin Migraine Pain, Nuprin] or their equivalents after surgery. Aspirin or similar products such as ibuprofen and naproxen [Aleve, Aleve Caplet, Aleve Easy Open Arthritis, Aleve Gelcap, Anaprox, Anaprox-DS, Comfort Pac with Naproxen, EC-Naprosyn, Leader Naproxen Sodium, Midol Extended Relief, Naprelan '375', Naprelan '500', Naprosyn] can increase the likelihood of bleeding. If it is necessary for you to take these drugs, ask your doctor prior to the surgery.)
• Avoid any other blood thinner medications that might slow down healing time. Prior to the procedure, your surgeon will discuss your medications with you and make appropriate recommendations if you are taking blood thinner medications (medications that interfere with blood clotting).

It is rarely necessary to go to the hospital after mole removal. If catastrophic bleeding occurs or if there is an alteration in mental state or severe infection, this may warrant a visit to the hospital's emergency department.

• Usually, it is best to call the surgeon's office if time permits to make sure the doctor does not have a suggestion, which may eliminate the need to go to the hospital.
• If excessive bleeding occurs, hold firm pressure on the wound for at least five minutes.
• Also, ice may be applied to the wound for pain management, but ice does not stop bleeding (contrary to popular myth).

Doctors remove many moles every day, but there is always one recurring theme that dermatologists tell people: Be aware of your body and any moles that have changed over time. This is especially true for moles that are dark or flat. Invariably, people will see doctors and be extremely concerned about raised, lightly colored moles, but they are not concerned about the dark, black melanoma (skin cancer) next to the mole. This is truly important.

Additionally, it is imperative to stay out of the sun and wear sunscreen when you are outside. If you do go to your dermatologist for evaluation, be receptive to a full body mole screening because it is important to look over your entire body rather than ignore areas that you may not be able to inspect regularly.