Mole Removal 101: Your Comprehensive Guide

Mole removal is a cosmetic procedure that can give you not only aesthetic benefits, but also relief if you suspect that your mole could grow or become cancerous. While some dermatologists may offer to scrape the mole, it is better to find a dermatologist or doctor that can remove your mole as fully as possible. A commonly used method for mole removal is excision with a suture closure. This method helps ensure that pigmentation does not return and so that it becomes difficult to see a scar. [Ref. 1] You can benefit from having a mole removed if it is bleeding, itchy, or has changed in any way- due to the potential that it could result from skin cancer. [Ref. 3]

Most individuals have at least forty moles, but there are individuals who have up to six hundred. Moles can sometimes develop due to UV rays or having a poor immune system. [Ref. 17] Although it is an elective procedure if your mole is deemed non-cancerous, it can have a drastically positive impact on an individual’s quality of life to be able to live without the embarrassment or shame that an excessively large mole in an odd location can cause. [Ref. 9] Elective mole removal is not always purely cosmetic. Moles can sometimes become a nuisance if they are often nicked during shaving, or if they are pinched or painful when changing clothing or completing daily activities. [Ref. 11]

The perception of moles has varied drastically throughout time. In ancient Rome, fake moles were sometimes used to indicate looks, status, and moral standing. In traditional China, mole-reading was a form of fortune telling, while in Medieval Europe, moles were considered a bad omen. The art of face-reading in China was called Mian Xiang and carried great significance for academics and military strategy. One of the military strategy schools was run by Gui Gu Tze, and his mentees later became advisors to the country’s future leaders. When Mao later outlawed face reading, many face readers left to continue their work in Taiwan.

In Medieval Europe, women were often persecuted for perceived potential witch status their communities believed to be indicated by a mole. Suspected witches would often be shaved and tortured into confessions prior to being brutally killed. [Ref. 19] However, by the 17th century, particularly in Europe, moles came into vogue as a fashionable beauty mark, and many women chose to wear fake moles. By the 18th century, particularly in England, it was common to buy and wear fake moles, and these moles were used to indicate your political allegiances by placement. Fake moles came in incredibly diverse different materials, which included taffeta, velvet, and silk. They also came in a wild variety of different shapes, which included heart, clubs, and wands. [Ref. 19] However, by the Victorian era, moles had once again fallen out of fashion. They are now once again considered a cosmetic defect to be fixed and obscured. [Ref. 9]

The type of mole you have could be common, atypical, or congenital. Congenital moles are on the body from birth and can be considered a birth mark. These moles almost never develop into a melanoma. Common moles are moles that develop post-birth, and they typically are small and circular. Common moles have the potential to develop into melanoma, however, this is a rare occurrence. Atypical moles, however, have the most potential for developing into melanoma, due to their atypical shape, size, and texture. [Ref. 11]

There are misconceptions when it comes to mole removal, and when mole removal is the best option. A common misconception is that common and atypical moles will not develop into cancer, but this is statistically proven false. There is also a misconception that it is better to leave a mole alone than to remove it; however, this is also false due to the potential for cancer and the impact of an irregularly placed mole on one’s mental health. Another misconception is that it is safer if all moles are removed simultaneously. This is not necessarily true, because it is expensive and could potentially cause more scarring than a single mole removal. Another misconception is that removal with laser is the best and only solution. Depending on what kind of mole you have, removal with laser can be a good option, but it is not the only reliable option for removal and all options should be considered prior to moving forward with any treatment. [Ref. 12]

It is important to consider what type of mole you are dealing with prior to going to a dermatologist or doctor. Doctors are skilled in both invasive and non-invasive techniques. Dermatologists, however, are only skilled in non-invasive procedures. While dermatologists may be best suited for minor mole removal, doctors can remove large moles due to the ability to use laser treatments and scar revision to deal with the scar tissue from large mole removal. [Ref. 2]

There are multiple ways in which to remove moles that are an option for patients. Electrodesiccation and electrocoagulation are ways in which moles can be successfully removed, while minimizing the potential for cancerous grown and scar tissue. [Ref. 4] Red and near infrared lasers incorporate melanin’s selective absorption with a specific level of penetration to the skin. This makes far-infrared skin resurfacing lasers and pulsed lasers/IPLs an excellent choice for mole removal. Pulsed lasers/IPLs are especially useful because they can target larger hair follicles and group of nevus cells. [Ref. 5]

If you do choose to get a mole removed, you should recognize the difference between moles that may need to be biopsied by a cancer specialist, versus moles that should be removed for cosmetic regions. If you find that your mole is best suited for cosmetic removal, you can make an appointment with a doctor or dermatologist instead of a cancer specialist. A mole needs to be reviewed by a cancer specialist if it has an uneven border, is asymmetrical, is oddly colored, has a large diameter, or is changing in any other way. However, whether your mole removal is cosmetic or not, you should confirm with your doctor that the mole can and will be completely excised. [Ref. 6] If a mole is shaved, it can sometimes allow brown discoloration to recur at the base of the shaved mole and allow the mole to reform later. This is best prevented by ensuring all moles are as completely excised as is possible. [Ref. 15]

It is best to opt out of removing a mole yourself, and always go to a doctor or dermatologist to have a mole removed. Occasionally, highly active skin growths, like tags or callouses are easy to remove at home. However, moles cannot be removed in the same way due to the way it is imbedded in the skin. Home removal will put you at risk of scarring and infection. [Ref. 13] While at home mole removal kits may be tempting, particularly during a pandemic, these kits also come with a variety of unpredictable side effects that can be difficult to review for risk and mitigation strategies. Another risk factor for self-removal is that if you are potentially cutting off a melanoma yourself, you may leave part of that melanoma in the skin, which allows the cancerous cells to continue to spread and cause harm. At home removal also doubles the potential risk of infection after you have excised the mole in question. [Ref. 18]

Mole removal is typically something done in an outpatient setting, where you are given a localized anesthetic like lidocaine and kept awake. For cosmetic procedures, the removal process is typically limited to the mole itself and not the surrounding tissue. You may require stiches once the mole has been completely excised if it is particularly large. The recovery time for this procedure ultimately depends on how deeply inset the mole is and how clean you can keep the area where the mole has been removed. It is important to keep the area where the mole is excised as dry as possible in the days post-surgery. It is also typical to be scarred post-removal, but whether the scar last will depend on the size and location of the mole. [Ref. 6]

Moles are sometimes removed by surgical excision, but they can also be removed by shave excision if they are small and thin enough. This procedure requires that your dermatologist or surgeon use a thin, small, and sharp tool to carefully scrape away the moles. The difference between this excision and the surgical excision is that your doctor will cut through the subcutaneous fat layer while completing a surgical incision. [Ref. 7] Another option for mole removal that you can discuss with your dermatologist or doctor is freezing. In this procedure, your doctor may use liquid nitrogen to freeze your mole off, and you will develop a blister rather than a scar where this was completed. [Ref. 8]

Typically, if a mole is removed cosmetically, your doctor or dermatologist can point you to methods to minimize scar damage. This can be useful for hypertrophic scars, which occur when the body creates too much collagen while healing, and for keloid scars, which tend to be larger than hypertrophic scars. Healing after mole removal can take anywhere from two to three weeks to be complete. To avoid having to visit your doctor for multiple procedures, it is recommended that post surgery you avoid direct sunlight, avoid pulling on the scar, keep the incision site clean, massage any scarring regularly, and place pressure and a dressing on the wound from the mole’s removal. [Ref. 7]

If you choose to get a mole removed, you can rest assured that all questions will be answered by your dermatologist or doctor prior to the procedure. After you have discussed your options, and how you would like your mole to be removed, you can schedule your appointment. The most common means of dealing with moles are shaving or scalpel removal, but your doctor may opt for freezing or lasers depending on the nature of your mole. [Ref. 14] The method of shaving that is most used is called curettage. This is completed by using a small instrument with a serrated loop. This is a way to remove a mole that is slightly less invasive. [Ref. 20] You are a particularly good candidate for mole removal if you have multiple moles, discolored moles, or moles in strange locations. [Ref. 16]

Dermatologists and doctors typically try to determine what the least invasive option for removing your mole can be and the best means to approach your specific situation. Dr. Julia Tzu, of Wall Street Dermatology, explains on her website that cosmetic mole removal is one of the most fulfilling procedures for dermatologists, due to how low risk the procedure is and how happy patients are after getting rid of the unsightly moles that they have tolerated for far too long. [Ref. 15]

Mole removal with lasers can range from 150-1500 dollars, depending on the size of the mole. Mole removal is sometimes covered by insurance, however, if it is completely elective and cosmetic, your insurance will likely not cover the expense. Additionally, if you choose to remove your mole with a laser, it will take about 2 or 3 laser treatments to complete the process, over the course of about two months. If you choose a laser treatment, you will need to not ingest any medications that cause blood thinning for two days prior to treatment, avoid alcohol for two days prior to treatments, and stop using skincare products like retinols before and after treatment. Additionally, it is necessary to avoid hot water, and sunlight for several days after your laser procedure is completed. [Ref. 16]

References:

1. https://www.kalos-plasticsurgery.com/the-benefits-of-cosmetic-mole-removal/

2. https://www.farberplasticsurgery.com/the-advantages-of-seeing-a-plastic-surgeon-vs-a-dermatologist-for-cosmetic-procedures/

3. https://www.texasfaceandnose.com/benefits-mole-removal/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1521766/pdf/califmed00216-0040.pdf

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663172/

6. https://www.self.com/story/what-to-expect-mole-removal

7. https://www.healthline.com/health/mole-removal-scar#surgery-and-scars

8. https://www.beaumont.org/services/find-a-beaumont-primary-care-doctor/non-cancerous-mole-removal

9. https://www.bbc.com/news/magazine-34768397

10. https://medlineplus.gov/genetics/understanding/traits/moles/

11. https://franklinlaser.com/blog/what-can-laser-mole-removal