Mole Removal

Mole RemovalMole Removal
What is the best way to remove a mole?
We have three choices:
1 - Excision with stitches
2 - Shave excision
3 - Leave it alone

(Reminder: This applies only to benign-appearing moles that we are removing for cosmetic purposes.)
Excision with stitches:
This is also called a “full-thickness excision” and is essentially just cutting the mole out in the same way that we would cut out a skin cancer (see figure).  This is the only method that removes the entire mole because we actually go deep enough (down to the subcutaneous fat) to remove the lesion in its entirety.

PROS   The entire lesion is gone and has almost no chance of recurrence.
CONS   Stitches are required and the scar is usually larger than if we had done a shave excision.
  This is appropriate for a suspicious mole where the goal is to remove the entire mole so that the pathologist can examine it under the microscope.

Shave excision:
Mole Removal
This is a method where we use a flat scalpel or razor blade and simply numb up and shave off the mole (we shave it flat).  This method gives the best cosmetic result provided that two criteria are met. Criteria #1 – the mole is raised enough that it is easy to shave off; Criteria #2 – the mole is in a “good” location that tends to heal well and with minimal scarring . An example of a “good” location is the face.  An example of a “bad” location in some people is the chest or shoulders. However, even in a “bad” location, the right mole (the raised fleshy kind) can be shaved off with an excellent cosmetic result.

PROS   The best cosmetic result.  The result is often a scar so small that we can’t even find it a few months later. No stitches needed.
CONS   The entire mole is not removed, therefore the mole may come back (although this is rare, and when it does occur it is often years later).  I have also occasionally seen the mole heal as a dark but flat mole, but with time the darkness tends to fade.
  When the goal is to remove a raised benign-appearing mole for the best cosmetic result.

Or leave it alone:
“scoop” it out.  Whenever we have to “scoop” a mole out rather than just shave it flat, the scar tends to be worse than the original mole.  On the other hand, whenever we remove a mole that is raised enough that we can simply shave it flat, the mark left (if any) tends to look better than the original mole.