Mole Removal 101: What to Consider - by Harvard-trained Dermatologists - Risks, Scarring, & Recovery — Boston Derm Advocate (2024)

everything you need to know

Written By David Li

Mole Removal 101: What to Consider - by Harvard-trained Dermatologists - Risks, Scarring, & Recovery — Boston Derm Advocate (1)

Table of Contents

What Exactly is a Mole?

What Causes Moles to Develop?

Are Moles Cancerous? How to Tell if a Mole Might Be Cancerous

Why Would a Mole Need to Be Removed?

Dysplastic Nevi and Atypical Moles

How is a Mole Removed?

What to Expect During the Mole Removal Procedure

Recovering From Mole Removal: What to Expect

Results After Mole Removal: What Will the Area Look Like?

Are There Risks With Mole Removal?

When Should I See a Dermatologist to Get a Mole Checked?

Key Takeaways: Mole Removal Essentials

Frequently Asked Questions (FAQs)

Moles are extremely common skin growths. While the vast majority of moles are harmless, some may be cancerous or may become cancerous over time. Mole removal is a simple procedure that can be done to eliminate moles that are problematic, whether for medical reasons or cosmetic concerns. This article will cover everything you need to know about mole removal, including why moles may need to be removed, the different mole removal methods, what to expect during the procedure, recovery and aftercare, and potential risks.

What Exactly is a Mole?

A mole, also known as a nevus, is a cluster of melanocytes, which are the pigment-producing cells in the skin. Moles are usually brown or black in color, but can also be skin-colored, pink, red, or blue.

Moles can appear anywhere on the body, including the face, torso, arms, legs, scalp, genitals, and bottoms of the feet. They come in many different shapes and sizes. Some moles are flat while others are raised.

The majority of moles are acquired during childhood and adolescence. On average, adults have 10 to 40 moles on their body. Hereditary factors play a role in the development of moles, so it's common for them to run in families.

Moles may change in appearance over time. As you age, some moles will fade away while others may darken. People can make new moles into their 30s-40s, however making new moles after ~age 40 can be a sign of an abnormal or cancerous mole and should prompt evaluation by a dermatologist (Tsao et al. 2003). During pregnancy, existing moles may darken.

What Causes Moles to Develop?

Moles occur when melanocytes grow in clusters rather than being spread evenly across the skin. This localized growth results in a mole.

Sun exposure, particularly during childhood and adolescence, is thought to play a role in mole development. The number of moles a person has is partly related to cumulative sun exposure over their lifetime.

Hereditary factors also influence the development of moles. People with fair skin, light hair, and freckles are prone to having more moles. Additionally, some families can make more moles.

Hormones may also affect moles. Some moles darken during pregnancy due to increased estrogen levels. Moles can develop during pregnancy even in women who did not previously have any. While moles on certain areas of the skin, ie the breasts or the abdomen, may appear to grow during pregnancy, recent studies actually suggest that moles should not be expected to grow or change due to pregnancy alone, especially if they develop features that are concerning, and therefore should be evaluated and sampled according to clinical assessment (Bieber et al. 2016). Further, it is safe to biopsy worrisome moles during pregnancy.

Are Moles Cancerous? How to Tell if a Mole Might Be Cancerous

The vast majority of moles are benign and no cause for concern. However, a small percentage of moles can be cancerous or can eventually transform into skin cancer (Tsao et al. 2003).

Some signs that may indicate a concerning or atypical mole that should be evaluated include:

Any mole that exhibits these red flags or just seems unusual should be evaluated promptly by a dermatologist. A biopsy to test the mole is usually necessary to determine if a mole is cancerous and if the skin cells are behaving abnormally (possible sign of skin cancer). A scary mole may also return after biopsy or removal as a common mole that requires no further action.

Mole Removal 101: What to Consider - by Harvard-trained Dermatologists - Risks, Scarring, & Recovery — Boston Derm Advocate (2)

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Why Would a Mole Need to Be Removed?

There are several reasons a mole may warrant removal:

Medical purposes:

  • The mole appears potentially cancerous based on its appearance and characteristics

  • A biopsy indicated abnormal or cancerous cells within the mole

  • The mole is large, bleeding, painful or causing other symptoms

  • The mole has changed significantly or grown rapidly over time

  • Removal for further pathological testing if melanoma, a form of skin cancer, is suspected

Cosmetic reasons:

  • The mole is large, darkly pigmented, or located in a conspicuous area and you wish to have it removed for cosmetic reasons

  • Multiple moles cluster together creating an undesired appearance

Patient preference:

  • You have a personal preference for removal of a mole even if it appears benign

  • The mole is located in an area like the face, neck or hands leading to self-consciousness

  • The mole gets irritated and bleeds occasionally and you want it gone to avoid dealing with it

Overall, any mole that becomes problematic, whether due to suspicion of malignancy, irritation, or cosmetic concerns warrants consulting a dermatologist to determine if you are a candidate for mole removal.

Dysplastic Nevi and Atypical Moles

Some moles are classified as dysplastic nevi, meaning they exhibit abnormal features under the microscope but are not malignant. The amount of cellular atypia or dysplasia determines if a mole is mildly, moderately or severely dysplastic.

Dysplastic nevi often have a larger size, irregular border, and variegated color (King et al. 2014; McCourt et al. 2014). They may also be asymmetrical or have a fried egg-like appearance. While not cancerous, they do carry an increased risk of transforming into melanoma over time compared to normal moles.

When a dermatologist notes a clinically atypical appearing mole or a mole biopsy shows dysplasia, they may recommend complete excisional removal to prevent any malignant changes. Moles with severe dysplasia are more likely to warrant removal. Monitoring for any changes in dysplastic nevi over time is also important.

How is a Mole Removed?

There are a few methods that dermatologists can use to remove a mole. Before we get to that, we need to discuss removal versus biopsy. The terms may seem synonymous, but removal suggests that the dermatologist is attempting to remove the mole entirely, leaving no traces of nevus cells behind. For this reason, 'removal' is often done with a thin margin around the mole. On the other hand, a biopsy may only get a small portion of the mole to test it under the microscope. Its intent is generally not to remove the mole entirely and for that reason, it is usually a faster and less invasive procedure.

Here are the most common ways to remove a mole:

Surgical Excision

This is the most common and effective technique. It involves numbing the area with a local anesthetic and then using a surgical scalpel to shave off the mole and a margin of normal skin around it. The mole is then sent to a lab for analysis.

The skin is closed using sutures, which may be absorbable sutures that don’t require removal or non-absorbable sutures that need to be taken out after 7-10 days. Surgical excision results in the least conspicuous scars compared to other mole removal techniques.

Mole Removal 101: What to Consider - by Harvard-trained Dermatologists - Risks, Scarring, & Recovery — Boston Derm Advocate (3)

Punch Removal

A sharp, circular blade is rotated down into the skin to remove a cylindrical core of tissue that includes the entire mole and some surrounding normal skin. The circular defect created is closed with absorbable or non-absorbable sutures.

Punch removal or punch excision is quicker than surgical excision, and may be more appropriate for leaving a smaller scar and when the mole is smaller.

Mole Removal 101: What to Consider - by Harvard-trained Dermatologists - Risks, Scarring, & Recovery — Boston Derm Advocate (4)

Shave Removal

A blade is used to remove the mole so that it is level with the surrounding skin. No stitches are required since the mole isn’t removed deeply below the skin surface.

This type of mole removal is fast and easy to perform. It has a shorter recovery time than excision methods. However, there is a higher risk of the mole growing back compared to full excision.

What to Expect During the Mole Removal Procedure

When an atypical or suspicious mole needs to be removed after a biopsy has deemed it to be irregular, your dermatologist will remove the mole using a fusiform technique (commonly). This type of removal involves:

  • Numbing the area around the mole with a local anesthetic

  • Making an elliptical excision around the mole with a surgical margin of normal looking skin

  • Removing the layer of the skin containing the mole and adjacent tissue in one fusiform shape

  • Using sutures to close the wound edges

  • Sending the tissue for pathological analysis to assess margins and check for cancer cells

Having clear margins with no residual mole tissue is important to help ensure full removal and prevent recurrence.

The size of the margins taken depends on factors like:

  • Location on the body

  • Size of the mole

  • Irregularity of borders

  • Pathology results if a prior biopsy was done

  • Patient age and health status

For a very atypical or malignant appearing mole, margins may be as wide as 1-2 cm around the mole to ensure adequate removal.

After excising the mole, the sample is sent to pathology to be analyzed under the microscope. This helps determine if the mole had any precancerous or cancerous changes and whether the margins are clear.

If pathology results show positive margins, meaning mole tissue extends to the edge of the sample, further surgery may be need to extract more tissue. This helps get clear margins.

Recovering From Mole Removal: What to Expect

Proper wound care after mole removal helps minimize scarring. Here are some tips:

  • Keep the area clean and dry for 24-48 hours. Then gently clean with soap and water.

  • Apply an antibiotic ointment like petroleum jelly daily after the first 24 hours.

  • Change dressings daily or whenever drainage accumulates to prevent infection after a mole is removed.

  • Sutures or surgical strips will need to be removed 7-14 days after surgery.

  • Avoid pulling, picking or scrubbing the wound as it heals. This can widen scars.

  • Apply silicone gels and sheets to flatten and fade scars. Use for 6-12 months.

  • Avoid direct sun exposure. Always use SPF 30 or higher on scars.

  • Consider laser treatments to reduce discoloration and improve scar appearance.

  • If a scar becomes raised, thick or painful see your dermatologist. Early intervention helps revise scars (Son et al. 2014).

Additional methods to minimize scarring include:

  • Limiting exercise and repetitive motions of the affected area for 1 month.

  • Avoiding pressure on the site by using padded dressings.

  • Elevating the area post-surgery to promote drainage.

  • Applying petroleum jelly like Vaseline to keep the wound moist and help the skin heal.

  • Taking care to follow your dermatologist's wound care instructions exactly.

With proper aftercare and sun protection, mole removal scars will continue to fade over 6-12 months. See your dermatologist promptly if you have any concerns about how the removal site is healing.

Results After Mole Removal: What Will the Area Look Like?

The mole will be gone after removal. Initially there will be a wound that forms a scab before new skin covers over. Once healed, mole removal by excision or punch biopsy often leaves a round or oval shaped scar the same size as the original mole. The scar may start out reddish then fade gradually over many months.

With shave removal, no scar is visible but there may be some surface irregularity or discoloration where the mole was.

Proper wound care and sun protection after mole removal helps minimize scarring. Using topical scar creams starting a month after the procedure may help fade the appearance of a scar over time.

Are There Risks With Mole Removal?

Mole removal is generally a low risk procedure, especially when performed by a dermatologist. Potential complications include:

  • Risk of Infection - proper wound care reduces this risk

  • Bleeding - applying pressure can stop bleeding

  • Poor cosmetic outcome with a conspicuous, wide or raised scar

  • Recurrence of the mole - more likely with shave removal or laser

  • Permanent skin discoloration

  • Allergic reaction to numbing medication

  • Adverse reaction to anesthesia

Choosing an experienced dermatologic surgeon helps avoid complications and ensures the best cosmetic outcome from mole removal.

When Should I See a Dermatologist to Get a Mole Checked?

You should have a dermatologist evaluate any new, changing or suspicious looking moles to determine if removal is recommended. Also make an appointment if you have a mole that is:

  • Bleeding, painful, itchy or showing other symptoms

  • Rapidly growing or changing in size or color

  • Located where it gets frequently injured or irritated

  • Cosmetically troubling based on its size, location or appearance

Annual skin cancer screening exams give dermatologists an opportunity to monitor the moles on your body for any worrisome changes. If any abnormal mole is noted based on the appearance of a mole or if it's new and changing, then it may be considered for closer monitoring or biopsy/removal. You should consult a dermatologist promptly if you notice a mole after age 40 that is new or any changes in an existing mole. Early detection allows the best treatment outcomes if any mole were to become cancerous.

Key Takeaways: Mole Removal Essentials

  • Moles are benign clusters of pigment cells that nearly all adults have

  • A small percentage of moles can undergo abnormal changes or become cancerous over time

  • Moles may be removed for medical reasons if cancer is a concern, for bothersome symptoms, or for cosmetic preferences

  • Various methods like excision, punch or shave removal can be used to eliminate moles

  • Recovery after removal of the mole takes 1-2 weeks, with fading of scars taking months

  • Moles should never be removed at home due to risks like infection, scarring and recurrence

  • Any new, changing or concerning moles should be evaluated promptly by a dermatologist

  • What are the different methods that can be used to remove moles?

    Some common methods of mole removal include excision with a scalpel, punch biopsy, shaving, scraping, curettage with electrodesiccation, laser removal, and radiosurgery. The technique used depends on factors like the mole's location, size, and appearance.

    When should I call my doctor after getting a mole removed?

    Call your doctor if you have signs of infection like increased pain, swelling, redness, warmth, foul-smelling drainage, bleeding, or fever. Also call if the wound edges separate, you have a medication reaction, or any other concerns about your healing process.

    How do I know if I should get a mole removed?

    Consider get a mole removed if it is bleeding often, changing appearance, enlarging, symptomatic, cosmetically undesired, or your dermatologist determines it looks suspicious for an abnormal mole or concerning for a type of skin cancer after an evaluation.

    What should I expect the first few days after mole removal?

    Expect mild throbbing, swelling, bruising and tenderness for 1-4 days after mole removal as the skin heals. Follow your doctor's instructions for keeping the area clean and dry initially. Avoid irritating the wound during the early healing process.

    How long is the recovery time after a mole removal?

    The recovery time is typically 1-2 weeks but can vary based on the mole's size and location. Swelling and bruising tend to resolve within 2 weeks but complete healing can take 4-6 weeks. Most can resume regular activities after their follow-up appointment.

    Can I just remove a mole myself at home?

    Absolutely not - we do not recommend any attempt to remove a mole at home. We also do not recommend that moles be treated with cryotherapy or laser, because doing so renders it impossible to study the mole under pathology. Mole removal with proper surgery is safest when performed by a dermatologic surgeon.

    Will mole removal leave a scar?

    It's important to know what to expect after mole removal, specifically the scarring. There is often some scarring after mole removal, but proper wound care and sun protection can help minimize its appearance over time. The resulting scar often matches the size and shape of the original mole.

    What does the mole removal procedure involve?

    The mole removal process involves numbing the area, using a scalpel, punch, shave, or laser to remove the mole and margins, stopping any bleeding, closing the wound with sutures/bandages, and sending the mole for analysis.

    How long after mole removal can I resume regular activities?

    After mole removal, limit activity for 1-2 days. Avoid vigorous exercise for 2 weeks. Don't swim until fully healed in 4-6 weeks. You can resume all regular activities after your follow-up once your doctor confirms you are healing well.

    How do I properly care for the wound after mole removal?

    For proper mole removal aftercare, keep the area clean and dry initially, apply antibiotic ointment, change bandages regularly, avoid irritating the wound, take prescribed medications, and protect the site from sun exposure as it heals.

    What are the risks associated with getting a mole removed?

    Risks of mole removal include infection, bleeding, poor wound healing, visible scarring, mole recurrence, skin discoloration, pain, reaction to numbing medication or anesthesia. An experienced dermatologic surgeon can help minimize risks.

    How can I reduce scarring from mole removal?

    To reduce scarring, care for the wound as directed, massage the area once healed, use silicone gel sheets, apply moisturizer, avoid sun exposure, and consider laser scar revision treatments. Let your doctor know if scarring concerns you.

    What should I expect following mole removal?

    Expect mild pain, swelling, bruising, numbness, and tenderness for 1-2 weeks following mole removal as the skin mends. The area may remain slightly tender for a few weeks. Use Tylenol if needed for pain. Call your doctor if symptoms worsen.

    Can moles reappear after being removed?

    There is a small risk of recurrence after mole removal, especially with shave techniques where some cells can remain. The risk is lower with excision that removes the entire mole and margins. Notify your doctor if you notice any regrowth.

  • We are a group of dermatology residents and attending physicians based in Boston, MA. Our team of Ivy League-trained dermatologists is demystifying the cosmeceutical industry by offering unbiased, scientifically supported reviews of skincare products. We are extremely passionate about skincare and making it accessible to all through education. We value integrity, practicality, and inclusivity. No sponsorships were received for the products prior to testing; we feel strongly about providing un-biased reviews. After blogs are published, following the links in this blog post may result in commission.

    Dr. David Li is a recent graduate from the Harvard Combined Dermatology Residency Program. He is now in private practice as a procedural dermatologist in Downtown Boston where he offers skin cancer screenings, skin cancer surgeries, and laser and cosmetic rejuvenation. He has published more than 25 peer-reviewed research articles, is active as an advisor for multiple early-stage companies, and is an angel investor in the healthcare technology space. In his free time, he enjoys running to stay fit, cooking, and playing with his Australian shepherd, Laika.

    Dr. Jacqueline Stevens is currently a resident in the Harvard Combined Dermatology Program. She completed her undergraduate studies and MD-PhD at the University of Virginia with a PhD in microbiology, immunology, and infectious disease. Jacqueline has interest in cutaneous oncology, melanoma, and dermatologic surgery. She has published work on the basic science of inflammation at skin barriers, dermatologic diseases, and systems used to classify squamous cell skin cancer. In her free time, she enjoys skiing, hanging with her rescue pup, and the outdoors.

    Dr. Olivia Davies is a dermatology resident at the Harvard Combined Dermatology Residency Program. Her dermatology interests include inpatient dermatology, complex-medical dermatology and medical education. She enjoys exploring the intersection between medicine and media — with past experiences that include rotating through the ABC News Medical Unit, publishing a graphic perspective in the New England Journal, and serving as a poetry editor for Intima: A Journal of Narrative Medicine. When she’s not learning or working, she can be found making cheese plates for friends, sipping a warm cup of coffee, or solving the newest NYT crossword puzzle.

    Dr. Nelson Ugwu is a dermatology resident at the Harvard Combined Dermatology Residency Program. His clinical interests include general dermatology, skin of color and skin cancer prevention. Nelson has discovered mutations that cause skin diseases, as well as new treatments for skin conditions. In his free time, Nelson enjoys weightlifting, playing soccer and trying new recipes.

    Dr. Arash Mostaghimi is an associate professor of dermatology at Harvard Medical School, the director of the inpatient dermatology consult service, and co-director of theComplex Medical Dermatology FellowshipatBrigham & Women’s Hospital. He is also the principal investigator of the Mostaghimi Lab, where he leads a diverse group of physicians and researchers to study alopecia areata, an autoimmune hair loss condition which afflicts his daughter. In addition to his research, he is an advisor to multiple companies and is an associate editor of JAMA Dermatology.

References

  • Tsao H, Bevona C, Goggins W, Quinn T. The transformation rate of moles (melanocytic nevi) into cutaneous melanoma: a population-based estimate. Arch Dermatol. 2003 Mar;139(3):282-8. doi: 10.1001/archderm.139.3.282. PMID: 12622618.

  • Bieber AK, Martires KJ, Driscoll MS, Grant-Kels JM, Pomeranz MK, Stein JA. Nevi and pregnancy. J Am Acad Dermatol. 2016 Oct;75(4):661-666. doi: 10.1016/j.jaad.2016.01.060. PMID: 27646736.

  • King AJ, Gehl RW, Grossman D, Jensen JD. Skin self-examinations and visual identification of atypical nevi: comparing individual and crowdsourcing approaches. Cancer Epidemiol. 2013 Dec;37(6):979-84. doi: 10.1016/j.canep.2013.09.004. Epub 2013 Sep 26. PMID: 24075797; PMCID: PMC3849386.

  • McCourt C, Dolan O, Gormley G. Malignant melanoma: a pictorial review. Ulster Med J. 2014 May;83(2):103-10. PMID: 25075139; PMCID: PMC4113154.

  • Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014 Jun;29(6):751-7. doi: 10.3346/jkms.2014.29.6.751. Epub 2014 May 30. PMID: 24932073; PMCID: PMC4055805.

David Li

Mole Removal 101: What to Consider - by Harvard-trained Dermatologists - Risks, Scarring, & Recovery — Boston Derm Advocate (2024)
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