Mole Removal

The science of mole removal

• Excision provides the highest cure rate & predictable results
• A shave excision without stitches is best for raised moles
• Excision & stitches is best for flat moles 
• CO2 & pico lasers can be used in darker skin types
• Laser mole removal has a high recurrence rate as compared to surgery
• Laser mole removal should be employed in caution for lighter skin types with the risk of melanoma
• The major problem with laser mole removal is lack of a predictable outcome

How to remove a raised mole?

Raised moles are best treated with a shave under local anesthesia. This simple procedure takes approximately 3-8 seconds to perform using a free hand held blade. Cosmetic clinics will upsell a device called a RF loop or ‘laser.’ This is equally as effective as free hand shave excision. 

The recurrence rate following shave excision is much higher than excision with stitches, however the healing is often uneventful & the scarring is less. 

How to remove a flat mole?

Flat moles are best treated with surgical excision, with stitches to close the wound. Shaving using a blade or RF loupes are not recommended as it often results in an indented scar with partial mole removal. Lasers can be effective, however the results are not predictable. 

Flat moles are removed by your dermatologist or plastic surgeon. 

*We do not remove these moles in clinics. Our dermatologist is involved in complex cases of melanocytic naevi referred by other dermatologists. In select cases we may employ a pico laser to remove moles. This is done on a case basis. 

When do we use lasers & when do we use surgery?

Excision preferred for moles that are large, deep, or have suspicious characteristics that need histopathological examination. It provides complete removal but has a higher risk of scarring and longer recovery time.

Laser removal is ideal for small, superficial, and benign moles, offering a quicker and less invasive option with minimal scarring. However, it is not suitable for all types of moles, particularly those that might be cancerous, as it does not allow for a biopsy. This method requires a significant amount of hand holding as results are not predictable. 

Who to see for mole removal?

A medical or surgical dermatologist is the correct person to see if you are considering mole removal. Dermatologist manage moles in one of three ways-

1. Monitoring of moles: this is to exclude changes in a mole. Photography & mapping is the most common way to monitor moles. A good company is Mole Map. 
2. Elective removal of moles: this is on cosmetic grounds. 
3. Diagnostic excision of moles: This is to exclude dysplastic naevi & changing moles, namely to exclude a melanoma. 

*Our dermatologists at The Melasma Clinic do not monitor moles, we do not provide elective removal of moles on cosmetic grounds. We do however take complex cases that are not managed by other dermatologists, including management of congenital melanocytic naevi. A referral from your plastic surgeon or dermatologist is required. 

What laser techniques do we use?

We use a modified technique of CO2 with de-focused pico lasers. The CO2 is used to flatten the mole, whilst the pico laser is used to treat the pigment. This technique was pioneered by a Japanese surgeon & is frequently employed by many clinics in Asia. 

*Disclaimer: I only remove moles in select ethnicities (darker skin types have a lower risk of melanoma). This technique is not used in lighter skin types due to the risk of melanoma. 

**Laser mole removal is not routinely performed in our clinics due to the high risk of recurrence or impartial treatment. Moles in lighter skin types are not treated with lasers as the rate of melanoma (pseudomelanoma) is too high for our practice. A cosmetic GP or skin cancer doctor may offer you this option or alternatives.

What are the pros & cons of mole excision?

Excision (Surgical Removal) is the most reliable method of mole removal. In our clinic, this is the preferred method of mole removal as it is the most cost effective & effective method of removing a mole. 

Pros: 

Complete Removal: Ensures the entire mole is removed, including its roots, which is crucial for moles suspected of being cancerous.

Histopathological Examination: Allows for the removed mole to be sent for biopsy to check for cancer cells.

Effective for Large or Deep Moles: Suitable for larger or deeper moles that might not respond well to laser treatment.

Controlled Procedure. Surgeons have precise control over the depth and extent of tissue removal.

Cons. 

Scarring: Higher likelihood of noticeable scarring, especially if the mole is large or deep.

Stitches Required: Often involves sutures, which may require a follow-up visit for removal.

Longer Healing Time: Recovery can take several weeks, and the wound requires proper care to avoid infection.

More Invasive: A more invasive procedure compared to laser treatment, which can be intimidating for some patients.

What are the pros & cons of laser mole removal?

Laser mole removal is offered by many cosmetic clinics. It has some advantages but significant disadvantages. 

Pros:

Minimal Scarring: Tends to leave less noticeable scars compared to excision, especially for small and superficial moles. Scarring, if encountered, usually occurs after CO2 laser.

Non-invasive: A less invasive option that doesn’t require stitches, making it less daunting for patients.

Quick Procedure & recovery. The procedure is typically quicker, and recovery time is shorter.

Precise: Can target small < 2 mm, superficial moles effectively without damaging surrounding tissue.

Cons: 

Not Suitable for All Moles.  Less effective for large, deep, or potentially cancerous moles. Cannot be used for moles with an uncertain diagnosis because it doesn’t provide a sample for histopathology.

High risk of incomplete removal, leading to potential regrowth. This is the major factor why we do not employ lasers to treat moles. 

Since the mole is vaporized, it cannot be sent for histopathological examination to check for cancer. If the mole recurs & pathology is required, there is a chance that the mole could have features of melanoma under the microscope (pseudomelanoma).  

Multiple Sessions Needed: Some moles may require multiple laser treatments for complete removal. 

How much does it cost to remove a mole?

Careful consideration should be given to the cost. As a guide-

Laser removal single mole; $1290

Laser removal 2-3 moles; $1990

Laser removal 3-6 moles; $2790

As stated throughout this page, laser removal is not guaranteed, recurrence is frequent as is incomplete removal. Careful consideration should be given to these facts prior to removal. Factor in 1-3 sessions & the costs add up. 

*Procedure conducted by Dr Davin Lim on selected cases only.

What is a pseudomelanoma?

A pseudomelanoma, also known as recurrent mole, is a benign skin lesion that can resemble melanoma both clinically & histologically. It typically occurs after the partial removal of a mole through shaving or most commonly after laser mole removal. Key characteristics include:

Appearance. The mole often looks like a melanoma, with irregular borders and varied pigmentation.

History: It usually arises at the site of a previously removed mole, often within months of the procedure.

A biopsy is often necessary to distinguish pseudomelanoma from true melanoma. Histologically, it shows features of a recurrent nevus rather than melanoma, however most pathologists will be on the side of caution & call a pseudomelanoma a melanoma for legal purposes. 

While pseudomelanoma can cause concern due to its resemblance to melanoma, it is not malignant. Nevertheless, proper evaluation and diagnosis by a dermatologist are crucial to rule out true melanoma.

Do mole removal creams work?

Yes & no. If you use a high strength acid, it can remove a mole & replace it with a scar. Chemical agents such as cansema do the same.

How to stop moles from forming?

Preventing moles from forming can be challenging since they are primarily influenced by genetic factors & sun exposure. However, there are several strategies you can employ to reduce the likelihood of developing new moles:

Use Sunscreen. Apply a broad-spectrum sunscreen with an SPF of 50 or higher every day, even on cloudy days. Reapply every two hours, or more frequently if swimming or sweating.

Wear Protective Clothing: Wear long-sleeved shirts, wide-brimmed hats, and sunglasses to protect your skin from UV radiation.

Avoid Tanning Beds: Tanning beds expose your skin to harmful UV radiation, increasing the risk of mole formation and skin cancer. 

Since genetics play a significant role in mole formation, it is important to understand that some individuals are more prone to developing moles regardless of preventive measures. While you cannot completely prevent moles from forming, taking steps to protect your skin from UV radiation and maintaining regular skin checks can reduce the risk and help you detect any changes early. If you notice any new or changing moles, consult a dermatologist for a professional evaluation.

How to treat a scar following mole removal?

The algorithm goes like this- 

Silicon creams & gels can prevent & treat early scars. Failing that our dermatologist will use the following methods-

• Steroid injections if raised
• Vascular laser if red
• CO2 lasers if raised & red
• Dermal filler & lasers if the scar is indented

*Scar revision following mole removal may be conducted on selected cases. Please submit your request to drdavinlim.com. This service may be intermittently offered, based upon the requirement to train our physicians as it is more cost effective compared to scar revision by Dr Davin Lim.