Moles and skin lesions come in variety of shapes and sizes and cause a variety of problems. Often the most common reason for removal is that the client does not like the way the mole, cyst or other skin lesion looks and this causes them to feel self-conscious or embarrassed. Other reasons include a change in the appearance of the mole that makes them concerned it may be a skin cancer. Sometimes the client doesn’t notice the change in the mole but their partner, relative or friend notices and brings the change in the appearance of the mole to their attention. The system used to see whether moles may be a skin cancer is called the ABCD of moles.

A stands for Asymmetry. If the mole had an imaginary vertical line drawn through the middle of it, then both halves of the mole should look the same shape. If either half of the mole looks different to the other half then further investigation may be required.

B stands for border irregularity. The border of a mole is normally smooth, but if it is notched then it could mean the mole has changed into something that needs attention such as a skin cancer.

C stands for colour irregularity. A mole should be the same shade and colour throughout. If the mole has different shades of pigment then it could mean the mole has changed and needs investigating.

D stands for increasing diameter i.e. the mole is increasing in size. This usually refers to the horizontal measurement although moles can also grow vertically and increase in height forming a nodule.

before mole removal
After mole removal

Safe Mole Removal

The aim of mole removal is to provide a medically safe removal of the mole that is appropriate for the character of mole and also provide an optimal scar. I would recommend histology for any mole or skin lesion removal so the diagnosis can be confirmed. However, some clients decline this and this is at their own personal risk.

Types of Procedure

If a mole is clear of the ABCD and there is no hair growing through it, shave biopsy offers a safe compromise of removing the mole and leaving a scar that is the same diameter as the mole. This is done by making the mole numb with an injection of local anaesthetic and using a blade to evenly remove the mole at the level of the adjacent skin surface. The disadvantage of this method is that the base of the mole still remains so the mole may recur later in life. If a client has multiple benign-appearing moles, then this can offer an attractive way of removing them.

If a mole has shown changes in the ABCD system or has hair growing through it, then a shave biopsy is not appropriate as the whole mole needs to be removed then analysed i.e. sent for histology. The skin with the mole is made numb with a small injection of local anaesthetic and a narrow border of normal skin is taken with the mole.

Although clients think a short scar is a better scar this is not necessarily true. Evidence has shown that by making the shape around the mole an ellipse or rugby ball shape rather than a circular shape the skin is placed under less tension when the skin edges are closed and the scar although longer than the mole eventually heals with a narrower, paler and more pleasing appearing scar. The edges of the remaining hole where the mole was removed are then closed with fine stitches called sutures.

Sutures that need removing that are made of nylon or a high-grade plastic called polypropylene are commonly used but sometimes clients request placement of dissolvable sutures. The advantage of using sutures that need removing is that the sutures do not remain in the skin for a long time and so do not cause inflammation in the surrounding skin. Inflammation causes redness in the scar and can occasionally lead to a less favourable looking scar.

Dissolvable sutures dissolve over a few weeks and can be rubbed away in the shower or bath but they can cause redness in the skin and occasionally stitch marks. These are dots in a row running parallel to the actual scar. The dots are small scars from where the sutures were placed. Stitch marks can occur when sutures that need removing are left in too long before removal.

Incision biopsy is the name given to removing part of a mole when there is uncertainty of the diagnosis or if the mole has changed using the ABCD system. Moles that are large patches are sometimes biopsied. Some of these moles are present at birth and are called congenital melanocytes naevi. These types of birthmarks are sometimes hairy and are then called hairy congenital melanocytes naevi.

Sometimes when a mole is removed, the resulting hole cannot be closed by suturing the edges together. The way the hole is filled is by re-surfacing the hole with a piece of skin of similar size that matches the colour and texture of the mole. For moles on the face, including the nose, a good skin match is by using a small skin graft from behind the ear. The area where the new skin is taken from is called a donor site.

If the complete thickness of the skin is taken, this is called a full-thickness skin graft. If however only a the top layer of skin with parts of the second layer are taken, it is called a partial thickness skin graft. Skin grafts are held in place with fine stitches and take around five days to pick up the blood supply from the adjacent skin. Although clients are sometimes put off with the idea of the skin graft, the appearance is generally excellent and it provides a safe and cosmetically pleasing way or removing moles that may have changed according to the ABCD system.

Sometimes a mole is removed and the remaining hole can be filled using skin that is nearby the hole. This skin has a blood supply and is called a flap. Similar to a tailor, the skin flap is designed and then moved into position allowing a cosmetically pleasing way of filling the hole.

Cysts are removed by making the surrounding skin numb. Depending on the size of the cyst, the scar can vary in length, but normally the scar is a little longer than the diameter of the cyst. Scars are orientated to match the frown lines in our faces which begin to become more noticeable as we age.

Histology

Although the majority of moles that are examined appear to be non-cancerous, occasionally, a mole can be removed that was thought to be non-cancerous but is actually a skin cancer. The only way to know for sure is to have the mole analysed. It is the client’s choice whether they would prefer to have the mole analysed as it is an additional charge but that is the client’s own decision and personal risk. Histology provides microscopic evidence to support the clinical diagnosis made on the history and examination during the consultation.

before mole removal
after mole removal

Your Outpatient Visit

This procedure is performed as outpatient in a high-quality state of the art operating theatre with a trained nurse present.

Typical Duration Of Surgery

A single mole may take about 15 minutes to remove. The more moles that need removing, the longer the time it takes.

Anaesthesia Required

Skin lesions are removed by numbing the skin with a small injection. This is called local anaesthetic.

Healing Time

The wounds have stitches that need removing at about a week. Clients can shower as normal the evening of surgery as there is a shower-proof dressing over the wound. After two weeks, scars should be massaged (to help flatten the scar), moisturised (to prevent the scar becoming dry) and sunblock applied over the scar (to prevent the scar from tanning differently).

Risks associated with the procedure

  1. Bleeding (haematoma). Occasionally, after surgery, blood may pool under the skin (haematoma), this usually disperses spontaneously over 2 to 3 weeks, but very rarely needs to be drained surgically if larger and fails to disperse.
  2. It is important to recognise that a surgical incision contributes to a risk of the introduction of bacteria from the patient’s own skin. Such infection may be associated with tiredness, weakness, fever and muscle aches and pains. Antibiotics are not normally given during this procedure and there is no evidence that by giving antibiotics this reduces the chance of an infection occurring. If you experience any symptoms of infection, contact your clinic nurse or the advised out of hours contact number.
  3. Wound healing. Healing of wounds varies from patient to patient and even from one part of the body to another and is a gradual process. Smoking for the period leading up to your surgery and afterwards can seriously hinder the healing process.
  4. Small cysts called milia can form along the scar line. This is normally temporary, but sometimes may need surgical removal
  5. Scar variability and keloids. All prospective patients must be aware that the rate at which their scars may heal and fade are entirely variable and individual. Uncommonly, a scar does not heal in the normal way. This is known as hypertrophic scarring meaning the scar is excessively thick. Scars may be red, or highly coloured, thick, painful and may take several years to improve if at all. Although this an unusual problem, it cannot be avoided or diagnosed in advance.
  6. Incomplete removal. Moles may not be completely removed. As stated, a shave biopsy does not completely remove the mole and there is high chance of the mole appearing again. Sometimes a mole may look like it has been removed using the naked eye, but when the mole is analysed under the microscope, it is found that either the outer edge of the mole or base of the mole is still there. This is why histology is an important tool is confirming complete removal.
  7. Diagnosis of a skin cancer. It is rare that a mole that looks completely harmless according to the ABCD system is a skin cancer. However, sometimes, a mole is sent to histology and comes back confirming a form of skin cancer. If this occurs, a discussion will take place on the best course of management.

Cysts are common and are fluid filled sacs within or under the skin. They can become red, infected and cause pain as well as making a client self-conscious about their appearance. The commonest types of cyst are epidermal cysts and these are commonly found on the face and back. They occur when the hair follicles get blocked and the oils that would normally be secreted along the hair follicle and skin accumulate in their sac of origin causing the sac to swell.