Mole Removal at a Glance
- Best Results1-2 treatments
- Treatment Recovery1-7 days
- Procedure Time1-30 min
- Skin SpecialistMedical dermatologist
- Duration of Results?
- AnaestheticLocal
- Back to Work1-7 days
- Cost$-$$
Mole Removal
Moles are removed on either cosmetic grounds or cases of suspected cancerous change. A shave excision using a blade gives the best results. In some cases, an excision with sutures is recommended. Be guided by your dermatologist as to how to approach mole removal.
FactsFacts on Mole Removal
- Moles subtypes include intradermal, junction, & compound moles
- Some can be safely removed with simple shave excisions, whilst other require excision with sutures
- Laser can be useful in some but not all cases
- An age related decline in moles is seen in the fourth decade of life
- Radiofrequency loop ‘laser’ removal does not give any advantage over surgical blade shaving
- Over-correction of mole removal results in an atrophic scar
- Moles increase with age till 30 years old
What are ways to remove unsightly moles?
There are four methods of mole removal, they each have pros and cons.
- Laser mole removal: sounds high-tech, but the success rate is low.
- Shave excision with steel: the best way to remove moles.
- Shave excision with radiofrequency: what cosmetic GPs will sell you.
- Excision with sutures: is the best for suspicious moles.
What is radiofrequency loop or Tempsure RF mole removal?
This is a surgical no-stitch method to remove moles using electric current. A loop wire is used to cut through the mole itself. One of the major advantages is to reduce post treatment bleeding.
IMO this is a massive overkill & over service. A better result can be achieved with a free-hand blade & some aluminium chloride hexahydrate to reduce bleeding. The reason is that the loop wire does not provide a flush surface. This often results in overcorrection of the mole itself, leading to an atrophic scar.
*I do use Tempure / Pelleve RF & many other RF devices, but not to treat moles. Sometimes simple treatments are best.
Can lasers remove moles?
Yes. I have been guilty of making a few YouTube videos on this process. Lasers including ablative CO2 & erbium can flatten raised moles. I do perform this procedure as an incidental way of removing intradermal nevi on select patients (low risk of melanoma).
Pigment lasers including Q switch & pico lasers can be used to treat flat moles. Lasers can be effective, either partially or completely. The risks of lasers are discussed down below.
Disclaimer: I do not remove moles as a primary treatment. The risk of recurrence is too high for my practice. Discuss mole removal with your treating dermatologist.
What is the difference between removing a mole on cosmetic grounds vs suspicious mole removals?
If your dermatologist is suspicious of malignant or cancerous changes in a mole, they will undertake a procedure to remove the entire mole. An excision is the most common procedure, in some cases a deep shave is required.
For cosmetic removal of moles cosmetic outcomes are carefully considered. In many cases only a portion of the mole (raised bit) is removed. A deeper correction will result in a divot.
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What are the advantages and disadvantages of excision with stitches?
Your dermatologist will guide you through what is best in the context of excluding malignant change in your mole. The following is based upon cosmetic mole removal.
PROS of excision with sutures
- Mole & the cells are completely out (in most cases)
- Microscope analysis is performed to exclude cancerous cells
- Recurrence of mole is unlikely
CONS of excision with sutures
- Scaring
- Suture removal
- Takes 12 months for scar to remodel
- Limitation of activities post-surgery
Disclaimer: I do not remove moles on a cosmetic basis. Discuss this with your treating dermatologist. I do take on challenging medical cases including large congenital melanocytic naevi, CALM birthmarks, Ota-Ito & Hori dermal melanocytosis.
What is the recovery following mole removal?
For shave excisions including lasers, the skin heals within 5-8 days. No sutures are required. The area will be slightly pink to red for weeks to months.
For excisional removal, your stitches will remain in for 7 to 14 days, depending on the location of the mole. You will be required to limit your strenuous activities for 2-6 weeks, again depending on the location of surgery. The wound is weakest after suture removal; hence it will require taping. Most patients will heal with variable scarring. This can take 12 months or longer to settle down.
Will I scar following mole removal?
Yes, however this is highly variable. For proper shave excisions, the scar should, in theory, be the size of the mole itself. If your physician has over corrected the shave (either with a blade, RF loop or laser), you will have a depressed atrophic scar.
Excisional modalities for mole removal are always associated with a linear scar. This can be at best a fine line & at worse a keloid scar. Be guided by your surgeon as to the end result.
Disclaimer: I choose not to provide cosmetic mole removal, purely based upon the side effects I see. I will however treat any scarring you may have received from previous mole removal surgery. This includes surgical, laser or radiofrequency treatments of moles.
What can go wrong with mole removal?
A lot. With proper technique and conservative removal, these risks can be reduced. The most common complications I see from other clinics include-
- Over correction. Most frequently on the nose (midline) and apex of the cheeks. This is common with loop RF devices as the circular loop digs into the skin.
- Halo effect or rim effect. This is when lasers are used to treat the mole. The middle is lighter, the rim is darker.
- Spotty re-pigmentation is super common. Occurs when there are roots that extend into the dermis. Part of the mole comes back. It looks unnatural.
- Post-inflammatory hyperpigmentation of the treated area is common, especially in Ethnic skin types. Lighter skin patients usually go red. It can take 3-9 months to settle down.
- Hypopigmentation or lightning is fairly common. May fade over time, may also be permanent.
- Recurrence. I don’t class this as a side effect as if the mole has roots, this is bound to happen.
What is the very worst that can happen if you laser moles?
Dermatologists are aware of something called a pseudomelanoma. This refers to the histological pattern of moles when they are altered with lasers or radiofrequency (less common with surgery). If this happens you are in a whole lot of trouble. Why? Because your provider (the person who removed the mole in the first place), must make the call as to whether the pathology is a real melanoma or a lesion mimicking a melanoma.
How they normally decide is to order special immunohistology stains. They will also send your histology slides to other pathologists either in Australia or Internationally. In some cases, scans may be ordered. A clinical examination is mandatory to exclude lymph node spread (unlikely, but part of the exam). In most cases they will arrange a clinicopathological meeting to make the call. It is a big deal. If you have been labelled as having a melanoma, this has a massive impact on your life insurance & in some cases your job.
Your physician who is about to laser, shave or RF your mole will have an in-depth discussion with you regarding pseudomelanoma changes.
Why does ethnicity play a defining role in mole removal?
Dermatologists approach mole removal with a risk benefit ratio in mind. If you want to take a gamble on cosmetic mole removal, do a Google search & you will find many cosmetic GPs willing to take on your job request. Here is a little insight as to how specialists approach mole removal-
High risk patients are skin type 1 & 2.
Low risk patients are of darker skin type, namely Asians, Middle Eastern, South & Central American.
For low-risk patients, histopathology may not be required. The decision to obtain pathology is at the discussion of your dermatologist. For skin type 1 & 2, desiccation of moles (especially junctional & compound naevi) will increase the incidence of pseudomelanoma.
How to prevent moles from occurring?
You cannot prevent genetics, however you can reduce the chances of cancerous changes in moles. Sunscreen & sun avoidance is the most effective means of reducing the chances of malignant melanoma.
The natural history of moles is to increase from birth to adulthood. After the age of 30, you will have a natural involution of moles as their numbers decrease with time.
Who to see for mole removal?
Discuss this with your dermatologist as they may perform cosmetic mole removal. They will weigh up the risks & benefits of this procedure & guide you accordingly. Book a consultation with my colleagues at Clinic Cutis.
Disclaimer: I do not perform routine cosmetic mole removal procedures. I do however remove challenging birthmarks including congenital melanocytic naevi, as well as Ota/Ito birthmarks.
Davin’s Viewpoint on Mole Removal
I get it, if there is an unsightly mole, sure, on cosmetic grounds it may warrant removal. The whole idea of removing moles is to give you a better cosmetic outcome than having the mole there in the first place, unless the mole is suspicious for a melanoma. In this case you should have it removed and tested.
Mole-phobia is a form of BDD or body dysmorphic disorder, the lines are somewhat blurred. If you have a big-ass mole in a cosmetically significant area, say the nose, upper lip, chin, or the middle of your forehead, then it is fair game to consider removal. If you have scattered moles that look natural (objectively, not subjectively) & you think it is the end of the world, this may cross into the BDD spectrum. No amount of convincing will make you change your mind. My specialist skills are very limited in this subset of patients. Ideally you should see a dermatologist who has an interest in the management of body dysmorphia. They may work with a psychiatrist or psychologist.
I do however remove moles & birthmarks in select patients. Lesions I treat include challenging congenital melanocytic naevi, CALM or cafe au lait macules, Ota, Ito, & Hori Naevi.
Disclaimer: I do not perform routine mole removal. Why? Because the recurrence rate is too high for my mode of practice. I do however remove clinically significant moles on the nose, upper lip & other areas where moles are visible at a distance of 2.5 meter or more.
