Mole Removal

What is a Mole?

A mole is the common name for a dark spot on the skin referred to as a Nevus (singular) or Nevi (plural). Nevi are comprised of pigmented cells, called Melanocytes, that have grouped together instead of spreading out. Melanocytes are the cells responsible for producing melanin, which is responsible for the pigment (color)of our skin. The more pigment a person has in their skin, the darker their skin is.

Moles can be present at birth or may appear throughout life, typically within the first 40 years of life. The average number of moles for adults is between 10 and 40. Moles can appear from sunlight exposure, hormonal changes during pregnancy, or from age. Most moles appear above the waist on sun exposed skin.

Anatomy of the Skin

Melanocytes are typically located in epidermis and dermis of the skin. These are the two most superficial levels of the skin, as shown in the chart above.

Diagnosis

Although most small round pigmented areas of the skin appear to be moles(raised) or freckles(flat), a history, exam, and sometimes a biopsy must always be performed to be sure that they are not some other type of skin pathology. Skin growths such as seborrheic keratosis, warts, and skin cancer may initially appear as moles or freckles.

History

A mole is the common name for a dark spot on the skin referred to as a Nevus (singular) or Nevi (plural). Nevi are comprised of pigmented cells, called Melanocytes, that have grouped together instead of spreading out. Melanocytes are the cells responsible for producing melanin, which is responsible for the pigment (color)of our skin. The more pigment a person has in their skin, the darker their skin is.

Moles can be present at birth or may appear throughout life, typically within the first 40 years of life. The average number of moles for adults is between 10 and 40. Moles can appear from sunlight exposure, hormonal changes during pregnancy, or from age. Most moles appear above the waist on sun exposed skin.

Examination

A thorough clinical examination of a pigmented skin area should be performed, and the following should be documented:

  • Size – Most moles are 5mm or less in diameter (the width of a pencil eraser).
  • Shape – Most moles are round and symmetrical.
  • Border – The border should be regular and even.
  • Color – The color should be even throughout the area.

Some doctors will use a device called a dermatoscope to view the mole under magnification. This helps them gain further insight into the cellular nature of the tissue, and it may provide additional diagnostic clues.

Sometimes people use the term “the ABCDE’s of Moles” to remind individuals and health care providers of the essential elements to look for when evaluating a mole. The “ABCDE’s” are the following:

  • Asymmetrical – Is the area asymmetrical?
  • Border – Are there uneven borders? 
  • Colors – Does the area contains two or more distinct colors?
  • Diameter – Is the area bigger than a ¼ inch or 6 millimeters in diameter?
  • Enlargement – Has the area grown in size over time

Biopsy

Sometimes the doctor may feel that a biopsy of the pigmented area would be beneficial. This can be performed by either taking an “incisional” or “core biopsy”. This involves removing a portion of the area for evaluation under a microscope by a pathologist. Alternatively an “excisional” biopsy might be recommended in which the entire area is removed for evaluation.  The choice between an incisional and an excisional biopsy will depend on the history, location, and physical characteristics of the area.

Skin Cancer Evaluation-How to do a Self-Exam of your Skin

A self-exam of your skin should be performed monthly to identify any abnormal or changing skin areas. Here is how to perform a self examination of your skin:

  • After a bath or shower, stand in front of a full-length mirror in a well-lighted room. (Use a hand-held mirror to look at hard-to-see areas.)
  • Begin with the face and scalp, and then work downward, checking the head, neck, shoulders, back, chest, and so on. Be sure to check the front, back, and sides of the arms and legs. Also, check the groin, the palms, the fingernails, the soles of the feet, the toenails, and the areas between the toes.
  • Be sure to check the hard-to-see areas of the body, such as the scalp and neck. A friend or relative may be able to help inspect these areas. Use a comb or a blow dryer to help move hair so you can see the scalp and neck better.
  • Be aware of where your moles are and how they look. By checking your skin regularly, you will become familiar with what your moles look like. Look for any signs of change, particularly a new black mole or a change in outline, shape, size, color (especially a new black area), or feel of an existing mole. Also, note any new, unusual, or “ugly-looking” moles. If your doctor has taken photos of your skin, compare these pictures with the way your skin looks upon self-examination.
  • Check moles carefully during times of hormone changes, such as adolescence, pregnancy, and menopause. As hormone levels change, moles may change.
  • It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If you find anything unusual, see your doctor right away. Remember, the earlier a melanoma is found, the better the chance for a cure.

In addition to performing routine skin self-exams, people should have their skin checked regularly by a doctor. A doctor can do a skin exam during regular checkups and well visits. It is important to tell the doctor about any new, changing, or “ugly-looking” moles.

* skin self exam reproduced from the National Cancer Institute

Any lesions that do not have the typical appearance of a mole, have been changing, become symptomatic, etc., should be evaluated by a doctor. For more up-yo-date information regarding skin cancer and lesion evaluation please visit the following websites:

Types of Skin Moles

Moles can be categorized in many different ways, including when they developed, cellular classification, and the anatomical location in the skin. Below, are some of the more common classifications of moles. Classifications can also be combined to describe all of the characteristics present in a given mole.

Time of Development

Congenital

Congenital moles, referred to as congenital nevi, are present at birth or develop within the first year of life. They are caused by pigment cells (melanocytes) cells in the epidermis (top layer of skin), the dermis (middle layer of skin), or in both layers. Congenital moles can range in size from “small congenital melanicytic nevi” which are less than 1.5 cm to  “giant congenital melanocytic nevi (GCMN)” which can be larger than 20cm. Treatment of congenital nevi is controversial, as the removal can result in significant scarring, and there is no universally accepted protocol to determine if or when removal will reduce the chance of developing cancer. For more information about congenital nevi visit https://www.nevus.org. For a review of GCMN, visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900335/.

Acquired

Acquired moles are are the most common types of moles. They appear after the first year of life and may appear into adulthood. They typically develop as a result of genetics, skin type, and sun exposure.  Most acquired moles are benign. Still, all moles should be monitored since all moles have a chance of becoming cancerous.

Cellular Classification

Typical

A typical mole will not have any of the ABCDE characteristics of atypical moles

  • Asymmetrical – the area will be symmetrical
  • Border – The boarders will be even
  • Colors – The area will be one solid color
  • Diameter – It will be less than 6mm in diameter
  • Enlargement – It will not have undergone changes in size over time

Atypical

Atypical moles, referred to in medical terms as dysplastic nevi, are moles that exhibit irregular characteristics. They usually have an abnormality in one or more of the ABCDE’s of mole characteristics, such as an irregular boarder, abnormal color, asymmetrical shape, etc. Although dysplastic nevi share a lot of the same signs of cancerous moles, they are not considered cancerous. However, a person with dysplastic nevi has an increased risk for skin cancer. Individuals with multiple dysplastic nevi are at a higher risk of developing skin cancer than those with just one. There are also certain syndromes in which people have a significant number of dysplastic nevi including Atypical Mole Syndrome and Familial Atypical Multiple Mole Melanoma Syndrome (FAMMM).(https://rarediseases.info.nih.gov/diseases/9281/familial-atypical-multiple-mole-melanoma-syndrome)

All of these high-risk individuals should practice rigorous, daily sun protection, perform a monthly skin self-examination from head-to-toe, and be on a regular and consistent schedule of professional skin exams performed by a dermatologist or skin cancer expert.

Halo Nevi

Halo nevi are typically raised moles that have a surrounding ring (halo) of light skin that has lost its pigmentation. The light skin is due to inflammatory cells that infiltrate the area and reduce the amount of pigmentation. The reason for this cellular invasion is unclear. They are typically benign.

Location

Intradermal Nevi

Intradermal nevi are skin-colored or lightly pigmented moles that may blend in with the adjacent skin. The pigmentation is not as dark as other types of nevi because they are located deeper in the skin – in the dermis. Intradermal nevi are very common, and they typically develop in late childhood or adulthood, and they are typically benign.

Junctional Melanocytic Nevi

Junctional melanocytic nevi are located in the junction between the epidermis and the dermis. Junctional nevi are usually raised and darker in color than intradermal nevi. Junctional nevi develop between childhood and early adulthood, and they are usually benign.

Compound Nevi

Compound nevi show signs of both intradermal and junctional nevi. Their melanocytes are located both in the dermis and in the junction between the epidermis and dermis. These moles usually have a central, raised area surrounded by a flat area They typically have distinct borders and even pigmentation, and they are usually benign.

Reasons to Remove a Mole

There are several reasons to remove a mole:

  • Changes in size, shape, or color
  • Development of symptoms (bleeding, itching, scabbing, etc.)
  • Interferences with daily activities like shaving for example if the mole becomes repeatedly traumatized by the razor
  • Cosmetic purposes

Home “Remedies” for Moles

Moles should never be treated with home “remedies”.

Typical home “remedies” include:

  • Apple cider vinegar
  • Aloe Vera
  • Garlic
  • Banana Peels
  • Baking soda +  Castor Oil
  • Tea Tree Oil

These should all be avoided

Unfortunately, there are many home “remedies” that have been recommended, sold, and advertised for mole removal. There are multiple reasons not to remove a mole with home “remedies”:

  • The mole should be evaluated by a doctor prior to removal. Many times, a biopsy of the mole is recommended either before removal or at the time of removal. The biopsy is performed to ensure that the mole is not cancerous or pre-cancerous.
  • The melanin cells in a mole are deep in the epidermis and sometimes in the dermis. In order for a home “remedy” to be effective it would need to penetrate to that depth. If a home remedy does penetrate to that depth, it would be dangerous to use, and if it doesn’t penetrate to that depth (which is usually the case), it will be ineffective and will likely leave a scar.
  • There is a significant chance of scarring as the home “remedies” are superficial and not precise. This means that they do not only affect the mole cells, but they affect local normal cells as well, leading to scars which are larger than the original mole.
  • If lasers are often ineffective in penetrating deep enough to remove a mole, how likely is it that apple cider vinegar is going to do the job?

Mole Removal Techniques

There are two main categories of mole removal techniques: Surgical Removal Procedures and Destructive Procedures.

Surgical Procedures

Surgical procedures involve local anesthesia and surgically removing a portion or the entire mole.

Shave Biopsy

A shave biopsy is a procedure in which a portion of the mole is shaved off with a scalpel and is sent to a pathologist for evaluation under a microscope. Typically, the area will heal on its own without the need for sutures. This method is meant for diagnostic purposes, and it is not meant to remove the entire mole. After this procedure, it is likely that the mole will return rather quickly.

Surgical Excision

A surgical excision is performed when the entire mole is to be removed. This may be performed for three reasons:

  1. To make an accurate diagnosis when it is felt that a shave biopsy is not adequate
  2. To remove an entire lesion along with the borders or normal tissue after a shave biopsy reported abnormal results
  3. To remove a mole for cosmetic purposes

Since the mole is round, closure of the area after removal would result in a “bunched up” appearance. Therefore an elliptical excision is commonly performed to create a straight line closure. Although this leads to a more aesthetically appealing result, this closure will be 1.5 to 3 times larger than the original mole.

After a mole is excised, several sutures will typically be required to re-approximate the skin edges. These are normally removed within 3-14 days.

Destructive Procedures

Destructive procedures “destroy” the mole tissue rather than excising it. There are many destructive techniques. These techniques typically require local anesthesia but no sutures. They heal naturally similar to a scratch, scrape, or abrasion of the skin. There are 3 main drawbacks of destructive procedures.

  1. They do not provide tissue to be evaluated by the pathologist. So, a diagnosis is not made.
  2. They are not precise, and they “destroy” normal cells along with mole cells.
  3. They do not extend through the full thickness of the skin, and they may leave mole cells in the deeper layers of the skin, resulting in the recurrence of the mole.

Typical Destructive Mole removal Procedures

Laser

Laser treatment is probably the most commonly used technique. It may be successful in the hands of experienced laser operators and when used on an appropriate mole. However, lasers emit a large amount of destructive energy which can result in scarring of the mole area as well as the surrounding previously normal skin. Laser treatment typically does not reach the base of the mole and can therefore have a high incidence of recurrence.

Cryotherapy

Cryotherapy is a technique that is used to freeze the tissue and create a “frost bite” of the area. Liquid nitrogen is used to freeze the area to temperatures of −4°F to −22°F. The frost bite kills the tissues of the affected area. The issue again is that in order to transmit the cold to the deeper layers of the skin, the treatment has to be applied for a longer period of time. This leads to the death of a significant amount of healthy skin in the area, resulting in scarring.  In addition, the strong blood supply to a mole makes it resistant to the frost bite induced by cryotherapy. In contrast lesions such as warts are superficial and do not have as robust of a blood supply as moles do and therefore are much better candidates for cryotherapy treatment.

Electrosurgery

Electrosurgery is similar to the other destruction techniques, but it uses electricity to “burn” the tissue. The same issues that doctors find with other destructive techniques are found in electrosurgery. The burn isn’t deep enough and the mole recurs, or it is deep enough but a significant amount of healthy skin tissue is destroyed in an attempt to reach the proper depth, resulting in scarring.

The Vanish System

The Vanish Center specializes in the treatment of soft tissue abnormalities in areas of cosmetic concern.  Our team of Plastic and Reconstructive Surgeons, Oral and Maxillofacial Surgeons, and Pediatric Craniofacial Surgeons are specialized in the aesthetic removal of skin and mucosal lesions.

We developed the Vanish Skin Surgery System by combining surgical, and radiofrequency techniques with the knowledge of cosmetic surgery, skin resurfacing, and dermabrasion.  

Our center works as a team with our referring doctors to provide coordinated care for all patients.  From mole removal to reconstruction after cancer, our team works with our referring doctors to achieve the safest and most aesthetic results possible.

Over the past several years, we have been fortunate enough to remove skin growths and reconstruct skin defects in cosmetically significant areas for patients from all over the country. This type of surgery has become a rewarding and much-welcomed area of expertise for us.  We are grateful for each opportunity to provide the highest level of care for our patients

Principles of the Vanish Skin Surgery System

 Vanish system is used only by doctors who are properly trained in its methods and techniques. The system is a comprehensive approach to skin lesion evaluation and treatment consisting of:

  1. An in-depth medical, medication, scarring, and skin lesion history  
  2. A Clinical Examination
  3. A Skin Type Classification
  4. Dermatoscope Examination (when necessary)
  5. Incisional Biopsy prior to removal (when necessary)
  6. Removal of Lesions using the most cosmetically sensitive techniques
  7. Reconstruction using local and regional tissue flaps (when necessary)
  8. Pathologic evaluation of removed lesions
  9. Topical medications both before and after therapy, when necessary, to improve the final cosmetic results
  10. Intra-lesional medications before and after therapy, when necessary, to improve the final cosmetic results
  11. Consistent Communication with referring doctors (telephone calls, web conferences, photos, biopsy reports, etc. Whatever it takes to give each patient the highest level of care.)

The Vanish Center Mole Removal Procedures

Incisionless Mole Removal Procedure

The Incisionless Mole Removal technique was developed at the Vanish Center and is used for the removal of qualifying moles in cosmetically critical areas. The procedure uses a special radio-frequency device which  is used when to remove the mole without an incision. The radio-frequency device works differently from a laser because the tip of the device remains cold as opposed to a laser which generates a significant amount of heat on the skin. Excessive heat can lead to unnecessary scarring. At the Vanish Center, we feel this technique is superior to laser removal.

Precision Shave Procedure

The Precision shave technique developed at the Vanish Center is used when it is decided that a sample of the lesion should be taken, but an excisional biopsy is not necessary. This is a modification of the Incisionless Mole Removal technique with a sample of tissue obtained which is sent to the lab for evaluation. The technique utilizes microsurgical instruments as well as a specialized radio-frequency device to remove the mole. The results are the same or similar to the Incisionless Mole Removal technique. Agian, we feel the specialized radio-frequency device is superior to a laser because the radio-frequency device remains cool on the skin throughout the procedure while a laser may generate a significant amount of heat on the skin. Excess heat on the skin can lead to unnecessary scarring. 

Summary

In summary, the most important aspect of mole removal is an evaluation by a properly trained doctor to make sure tha the area is a normal mole and dysplastic, pre-cancerous, cancerous or some other type of pathology. If the mole is felt to be irregular, then a discussion with your doctor should be had about which procedure is recommended to ensure that a proper diagnosis is made and a treatment plan is formulated. If the mole is felt to be a typical mole, then one of the discussed removal techniques can be used to remove the mole, or the decision not to remove the mole can be made. The choice will be the patient’s based on their level of comfort with procedures and their aesthetic concerns. Removal techniques include surgical excision, shave biopsy, destructive techniques, and a precision shave technique. Remember, two of the most important things that you can learn from this article: do not use home remedies, and visit a dermatologist regularly for skin checks.

0/5 (0 Reviews)