Surgical removal of moles with pathological (PH) analysis
Moles, i.e., melanocytic nevi, are benign lesions that can appear on the skin as well as on mucous membranes. These are benign pigmented formations, clearly defined, usually round, and can appear on any part of the body.
Everyone has moles, although some are rarely present from birth (congenital nevi). Most moles develop during adolescence, and the majority appear by the age of 20.
Moles are not a cause for concern by themselves, but in certain situations and in certain individuals (mainly due to genetic predisposition and excessive sun exposure), they can undergo malignant transformation and turn into melanoma. Therefore, any change in a mole in terms of color, size, or shape is a sign that the mole needs to be surgically removed and sent for pathological (PH) analysis.
Which moles need to be surgically removed?
To assess moles, dermatologists have developed the ABCDE rules which patients can also follow during self-examination at home:
- A – Asymmetry: Asymmetry means one half of the mole has changed appearance compared to the other half.
- B – Border: The edges of the mole become uneven, jagged, or unclear.
- C – Color: A healthy mole has a uniform color (from light brown to dark brown). A change in color or the appearance of new shades including brown, black, red, blue, yellow, and white is considered pathological.
- D – Diameter: Moles with a diameter of 6 mm or more are considered at increased risk.
- E – Evolution: Moles should remain the same color, shape, and size throughout adulthood. If there has been any evolution or change in any way, this is a reason to see a dermatologist.
All moles that meet at least two of the ABCDE criteria are considered suspicious and should be surgically removed.
Frequently Asked Questions:
Before removal, a dermatological skin examination with dermoscopy is necessary. Sometimes changes that worry the patient turn out to be completely benign and removal is not needed, while others turn out suspicious and require intervention.
Even when dermoscopy shows a mole is benign, it can be removed. Removal of pigmented moles in that case is also done surgically by excising the entire lesion and sending the sample for PH analysis.
It starts with cleaning the surgical field, applying a sterile compress, local anesthetic is administered, and the lesion is excised completely with a scalpel. After that, stitches, sterile gauze, and a bandage are applied. The excised material is sent for PH analysis.
Patients should stop anticoagulant therapy (aspirin, warfarin, etc.) 3 days before the planned procedure. If needed due to anxiety about the intervention, the patient can take an anxiolytic or sedative 2 hours before the appointment. It is recommended the patient comes with a full stomach.
The treatment area is numbed using a local anesthetic injected intradermally around the site (lidocaine with or without adrenaline). After anesthesia takes effect, the procedure is completely painless.
The gauze and bandage are removed the next day, and the site does not need further dressing. Antibiotic ointment is applied preventively on the operated area. Stitches are removed after 7–14 days.
Since excision with a scalpel is performed, a scar is expected, but it can be very discreet and cosmetically acceptable if the patient follows the advice. Scar evolution usually starts pale pink and then fades. Scars can be softened with certain creams or laser treatments.
