Mole removal

When you come for mole removal, also called nevus removal, we first examine the mole you would like removed. During this consultation, you can share which aspect of its appearance bothers you or why you want it removed. If removal is appropriate, we numb the area, remove the mole, and close the skin. When needed, we send the tissue for microscopic examination.

The structure of a mole

A melanocytic nevus, a type of pigmented mole, forms when melanocytes (pigment-producing cells that give skin its color) gather together. These moles may be flat or raised and can range in appearance from brown to skin-colored. Their appearance varies according to the location of the cells within the skin and the pigment they contain.

Not every spot or bump commonly called a mole has the same structure. Skin growths on a stalk, known as skin tags, and some surface spots may consist of different tissues from pigmented moles. The medical term for the name you use to describe its appearance is clarified during the examination.

The visible colored area alone does not show which layers of skin contain the growth. Its shape at the surface and the distribution of cells deeper in the skin provide different information. The removal method takes into account the mole’s position within the skin as well as its surface.

Cosmetic and medical mole removal

Not every mole needs to be removed. Removal may be considered for a mole whose appearance bothers you or that rubs against clothing. If the examination identifies a growth whose diagnosis needs clarification, tissue examination also helps determine the decision about the procedure.

If you are considering mole removal for appearance, you can explain what bothers you about it. Its raised surface, location, or color may be the reason for seeking a consultation. The examination considers this expectation alongside the type of growth and the need for diagnostic investigation.

Removal for medical reasons may aim to obtain a tissue sample to clarify the mole’s structure. For a growth with an uncertain diagnosis or suspicious examination findings, the priority of the procedure is to provide a suitable sample for microscopic examination. Suitability for a cosmetic intervention and the need for a diagnostic sample are separate decisions.

Mole examination and dermoscopy

The examination looks at the mole’s size, borders, color, and surface. It includes how closely its two halves resemble each other, whether its color is uniform, and how it is distinguished from surrounding skin. These features complement each other. Color alone, for example, does not show the mole’s cellular structure or whether it needs to be removed.

The history includes when the mole was noticed and whether its shape, color, or size has changed. You can share any personal or family history of skin cancer during the consultation. If you have a pathology report (the result of microscopic tissue examination) from a previously removed mole, it helps clarify the structure of that earlier growth.

Moles can occur on the scalp, hands, and feet as well as the face and torso. When you seek advice about one mole, the examination may need to include other moles on the skin. Similarities between the growth you want removed and other moles, or a feature that sets it apart, may be meaningful during the examination.

Dermoscopy is an examination of the skin using a special light and magnifying instrument. A dermatoscope (the instrument used for this examination) helps reveal color patterns and structural details that cannot be seen with the naked eye. This examination from the skin surface differs from pathology, which examines cells under a microscope.

Dermoscopic findings are interpreted together with the mole’s external appearance and the person’s history. This assessment may lead to monitoring or tissue sampling. Photographic records can help compare appearances across examinations. Information about cellular structure comes from pathological examination of removed tissue.

A close-up photograph of a mole can provide initial information about its color and borders. A wider image showing its location helps describe its relationship to surrounding structures. Because lighting and sharpness can change its appearance in a photograph, a preliminary image review does not replace dermoscopic examination or any tissue examination considered necessary.

Which moles should a doctor examine?

ABCDE is an abbreviation that helps recall features of a mole that need attention. The letters stand for asymmetry, border, color, diameter, and evolution. You can use these categories to describe a change you have noticed. Diagnosis is made through a medical examination and any investigations considered necessary.

• A, asymmetry: One half of the mole differs in shape from the other.
• B, border: The edges look irregular, notched, or indistinct in some areas.
• C, color: Different colors or an uneven color distribution are present within the same growth.
• D, diameter: The mole’s size draws attention or it is growing; being small does not establish a diagnosis on its own.
• E, evolution: The size, shape, color, or surface differs from its previous appearance.

A mole that looks distinctly different from a person’s other moles can also prompt an examination. A newly noticed growth or one whose appearance has changed is not assumed to be an ordinary mole just because it is pigmented. Changes in less visible areas, such as the scalp, soles, or around the nails, are also included in the assessment.

The ABCDE features do not all need to be present together. A growth may draw attention under one of these categories or warrant further examination because of its overall appearance. Similarity to nearby moles and the person’s account of changes complement the examination findings.

Mole removal and closure

We apply local anesthesia to numb the area around the mole. We then remove the mole and close the skin according to plastic surgery principles. Before the procedure, we explain which mole will be removed and the incision plan for its location.

In surgical removal, the mole is taken out through an incision in the skin. The boundaries of the tissue to be removed depend on the mole’s location and examination findings. Stitches are used to close the skin when needed. The procedure plan includes both the growth to be removed and the surrounding skin.

The location of a mole affects the removal plan as well as its size. When removing a mole close to the edge of an eyelid, lip, or nose, the position of surrounding structures and the direction of skin closure are taken into account.

In excision (surgical removal of tissue), the depth of the incision and the surrounding tissue to be removed are planned according to the nature of the growth. The removal plan for a small, well-defined mole may differ from that for a broad skin growth. When a diagnosis needs clarification, the tissue needed for examination affects the approach to removal.

The incision is drawn with the surrounding skin lines and neighboring structures in mind. When needed, separate stitches are placed beneath the skin and at the surface to bring the edges together. The closure plan depends on the depth of the removed tissue and the mobility of surrounding skin as well as the mole’s diameter.

If the area left by the removed tissue cannot be closed directly, transferring neighboring tissue may be considered. A flap (tissue moved while maintaining its blood supply connection) or a graft (tissue taken from another area and transferred) may be used in certain repairs. Whether these options are needed depends on the location of the growth and the extent of the area to be removed.

Active skin disease at the treatment site, an uncontrolled medical condition, or a particular concern related to current treatments requires a separate assessment of surgical suitability. A decision to remove a mole for appearance may be postponed based on this assessment. For a growth that needs diagnostic investigation, assessment and tissue sampling are planned according to medical need.

When researching mole removal, you may encounter terms such as surface removal, surgical excision, or laser treatment. If diagnostic examination is needed, the chosen approach must provide a tissue sample suitable for pathology. Procedures that destroy tissue structure and microscopic examination of removed tissue do not provide the same information. The method is therefore selected after the growth’s diagnostic features have been explained.

Pathology examination

Examination of removed tissue under a microscope is called histopathological examination (examination of the tissue’s cellular structure). It investigates the appearance of cells and their arrangement within the tissue. Findings at the cellular level add to the information obtained from the mole’s visible color and shape.

Taking a tissue sample to investigate a diagnosis is called a biopsy. Removing a mole can also provide a sample for this examination. A request for microscopic examination means that the nature of the growth is being investigated; it is not, by itself, a diagnosis of disease. A pathologist examines the tissue and records the findings in a report.

The body site from which tissue was taken and its features on examination are recorded when it is sent for pathology. If more than one mole is removed, each sample needs to be identified separately. This allows the microscopic findings to be matched with the examination information for the relevant growth.

A pathology report may assess surgical margins as well as the growth’s cellular structure. A surgical margin is the outer edge of the removed tissue sample. The relationship of the growth to this edge is interpreted alongside the diagnosis and helps inform whether another procedure is needed.

A pathology report may contain medical terms and descriptions of cell distribution and sample margins. During the consultation, you can ask how these terms relate to the mole’s examination findings. Keeping a copy of the report makes the previous tissue type available for later assessments of the same area or another mole.

Multiple moles and combined planning

If you would like more than one mole removed, you can point them out during the examination. The incision direction and closure method may differ for a mole on the face and one on the torso. Being on the same person does not mean that the same removal technique must be chosen for every mole.

Mole removal may be considered as part of the same plan as another cosmetic procedure. In that case, the mole’s diagnostic assessment follows its own findings. A decision about a mole requiring medical investigation is made independently of the scope of the other cosmetic procedure. Each mole’s anatomical location is marked separately in the removal and closure plan.