Melanocytic nevus surgery

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [1]; Michel C. Samson, M.D., FRCSC, FACS [2]

When a mole is highly suspicious of being a melanoma, it might require removal and biopsy. Other indications for surgical excision may also be cosmetic.

Moles can be removed by laser, surgery or electrocautery. They leave a red mark on the site which morphs back to the patient’s usual skin color in about two weeks. However, there might still be a risk of spread of the melanoma, so the methods of Melanoma diagnosis, including e.g. excitional biopsy.

• When a mole is highly suspicious of being a melanoma, then it might need to be removed and biopsied (microscopic evaluation by a pathologist).

• Other reasons for removal may be cosmetic, or because a raised mole interferes with daily living (e.g. shaving).

• Moles can be removed by laser, surgery or electrocautery. They leave a red mark on the site which morphs back to the patient’s usual skin color in about two weeks. However, there might still be a risk of spread of the melanoma, so the methods of Melanoma diagnosis, including e.g. excitional biopsy.
• If the mole is not very deep, scratching it away could be an option as well. It would leave a scab and somewhat of a wound, but it would take most of the mole away, even though there might still be a slightly dark spot on the patch of skin.

In properly trained hands, some medical lasers are used to remove flat moles level with the surface of the skin, as well as some raised moles.

While laser treatment is commonly offered and may require several appointments, other dermatologists think lasers are not the best method for removing moles because the laser only cauterizes or, in certain cases, removes very superficial levels of skin. Moles tend to go deeper into the skin than non-invasive lasers can penetrate.

After a laser treatment a scab is formed, which falls off about seven days later, in contrast to surgery, where the fissure has to be stitched with sutures.

Many dermatologic and plastic surgeons first use a freezing solution, usually liquid nitrogen, on a raised mole and then shave it away with a scalpel. If the surgeon opts for the shaving method, he or she usually also cauterizes the stump.

Because a circle is difficult to close with stitches, the incision is usually elliptical or eye-shaped.

Electrocautery is also used for removing skin tags and only reaches the outermost level of skin so that scarring is not a problem.

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