Mole Removal Insights from the Dermatologist
What usually happens in order for a doctor to determine that a mole needs to be removed?
Is it always biopsied first? Is it just biopsied sometimes? What determines if a mole needs to be biopsied versus just removed?
A doctor looks at a mole and decides if it has worrisome signs for being a skin cancer. The term “mole” is actually not specific, and many people use it to describe a number of different, specific skin-growths.
The most important skin growth that people call a "mole" is a melanocytic nevus. These are made of melanocyte cells that have the potential to turn into melanoma – the most serious type of skin cancer. These "moles" are usually removed and tested, meaning they are biopsied. We typically don't simply destroy these types of "moles" with acid or burning because then we can't test them for cancer.
What happens before a mole is removed?
The mole is examined visually, and sometimes, the dermatologist uses a dermatoscope. This is a magnifying instrument that is used by some dermatologists to enhance the visual features of the growth. If the mole appears suspicious, then it needs to be biopsied, which means cut-out entirely or in-part and sent for testing.
Worrisome changes you might see in a mole include the ABCDE changes:
Ideally, the entire lesion is removed for the most accurate results if it is suspicious for melanoma. This is still called a "biopsy" because margins are not removed, yet. The doctor needs the diagnosis first to determine if margins need to be removed, and if so, how large.
There are times when it is not possible or advisable to remove the entire lesion for the biopsy (For example, if the mole is large or in a location where taking it all off would leave a disfiguring scar or not heal well).
Testing is done by placing the mole-specimen in a solution that rubberizes it so that it can be stained, sliced and mounted firmly on a glass slide and examined under the microscope. This allows the pathologist to see the cells and the skin structures, and determine if the lesion is cancerous.
What happens during the process?
First, the skin is numbed with a shot. The mole is then cut out, usually with a scalpel or a punch. A stitch may be placed to close the wound, if needed. A bandage is used to cover the wound and help the site heal well.
How long does the removal usually take?
If the mole is small, the removal may take only a few minutes. If it is large and/or if a surgical excision is necessary, then the procedure could take much longer.
What can people expect to feel, if anything?
The skin should be well-numbed, and mole-removal is usually painless. The numbing shot stings, though. The procedure time depends on how simple it is to remove the mole. It could be under a minute or hours! Complex biopsies may require general anesthesia.
What is the recovery process like?
Wounds heal quickly, but again, healing depends on how complex and extensive the biopsy procedure is. A small procedure may heal in a few weeks. A more complex one with extensive stitching may begin to heal in two weeks. But, the scar may be weak and vulnerable for up to three months depending on the size of the surgery, the location of skin involved and how well the skin heals.
Why might this leave a permanent scar?
All wounds heal with scars if the dermis is cut into. Because mole cells reach into the dermis, a biopsy must include this layer of skin. Healing of a dermal wound involves making collagen, and that is a scar.
Some scars can be almost invisible. Others will leave a noticeable mark for life. Also, some skin will heal with darker discoloration (called postinflammatory hyperpigmentation). Sun protection is recommended once the wound has healed enough that you are able to remove the bandage and any sutures have been removed. This will help prevent postinflammatory hyperpigmentation.
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