Type of mole removal for slightly raised facial mole?
Mole removal is a common request we get at my office, but the ways in which a mole can be removed are very different depending on the type of mole you're referring to: raised intradermal nevus, seborrheic keratosis, or a flat melanocytes nevus.
An intradermal nevus involves tissue that extends into the dermal layer. It typically requires an excision below the epidermis (for obvious reasons) that can leave a scar. Some are excised with a knife (scalpel) and sutures (stitches) if they’re large enough, while others can be removed with a deeper electrocautery (burning with a cautery device).
Seborrheic keratoses can be removed many ways, the most common being electrocautery (burning) which, when done delicately enough, has a very low risk of leaving a scar. These lesions sit on top of the skin, either above or just within the top layers of the epidermis, and as such can therefore be removed without going deeper into the layers of the skin. Topical or injected numbing agents can be used for tolerability, but the procedure is quick and requires little to no downtime. I always recommend diligent use of 30SPF afterwards to prevent hyperpigmentation (a dark mark) over the treatment area.
A newer treatment for larger seborrheic keratoses is ESKATA, a topical hydrogen peroxide treatment that can be applied one to two times a month apart to clear up the area. This treatment requires no numbing agent and feels like a slight stinging sensation. Some providers also used cryotherapy (liquid nitrogen treatment) to remove the lesions. Despite the name (cryotherapy), the treatment feels like a short-lived burning sensation While rare, it sometimes also leaves patients with blisters and scarring.
A flat melanocytic nevus, or brown freckle or patch, can be removed a multitude of ways depending on the appearance and size of the lesion and the provider you’re going to see. A sun or liver spot (flat brown freckles or patches) can be bleached (with appropriate agents and instructions by your provider), peeled with one or several chemical peels, or removed with a laser.
No matter what type of “mole” you want treated, there are some options that will suit your needs better than others. I strongly recommend that you consult with a board-certified dermatologist or plastic surgeon for appropriate treatment.
Scalpel sculpting is one of the safest ways to remove moles and skin tags. It is particularly effective at removing raised moles elevated above the skin's surface. The technique uses a delicate scalpel to micro-shave the mole, and leaves minimal scarring. The outcome is generally more aesthetically pleasing than excision, which requires deep cutting into the skin.
Most importantly, scalpel sculpting allows for a small sample of the mole to be sent to histology to ensure it is benign and contains no cancerous tissue. More destructive treatments such as electrocautery and cryosurgery completely eliminate the mole, leaving no tissue behind.
Dermaplaning can also be used in conjunction with scalpel sculpting to carefully abrade the skin after the sculpting, and even out irregular borders to smooth and blend the mole edges with the surrounding skin.
I would suggest you seek medical advice or consult with a board-certified dermatologist to explore your options. Avoid any over-the-counter or home treatments, mole removal creams, natural remedies, or using a razor blade to shave the mole as these may result in unpleasant side effects or skin problems, such as an infection.
Moles form when clusters of pigmented cells called melanocytes accumulate. Mole removal is generally a very safe, simple procedure when performed by an experienced dermatologist or plastic surgeon. A small mole on your right cheek can easily be removed by a shave or complete surgical excision, depending on your preferences and the opinion of your surgeon.
Cutting into a mole will not cause bleeding unless the mole is torn away from the skin, or the excision affects the area where the mole and skin meet. If you attempt to remove a mole at home using a cutting instrument like a sharp razor, you risk scarring and infection.
There is also the possibility that you’ll cause profuse bleeding if you make inadvertent contact with the capillaries in the skin, or that you will not remove all of the cells, meaning a higher likelihood of the mole redeveloping. More importantly, unless you know the difference between a cancerous mole and a benign one, you may inadvertently remove a mole that is harboring cancerous activity.
An experienced dermatologist will first examine your facial mole to determine if it requires a biopsy. If performing a shave incision, he or she will then use a scalpel to scrape the mole off so the surface is flush with the surrounding skin. Most dermatologists then use electrosurgical feathering to remove any remaining cells left behind and create an even, flat surface. The wound will heal on its own within two weeks, though the mole may return. Your dermatologist may choose to send the mole tissue to be checked for cancerous cells.
Full-thickness skin excision involves removing the mole and its base from the skin entirely so there is no possibility of it returning. This procedure requires sutures or stitches to close the excision, and some mild scarring may result. The appearance of scars can be improved with silicone gel sheets.
Mole removal should always be performed by an experienced board-certified dermatologist or plastic surgeon. Only an expert can examine the mole on your cheek to determine the most appropriate method of excision and if the tissue needs to be analyzed in a laboratory. Skin growths such as moles often appear innocent but in some cases are cancerous, thus best treated by a dermatologist who can evaluate whether it’s necessary to send a tissue sample to pathology to determine if it’s benign.
There are three main mole removal procedures: shave excision, cryotherapy and complete excision. All of these procedures are relatively straightforward and can generally be performed as routine, in-office procedures. Mole removal should never be performed at home. Undertaking a shave excision of the mole at home can result in excess bleeding, infection or unsightly scarring.
Shave excision is carried out with a scalpel. This technique is commonly used by dermatologists for very raised or small facial moles as it doesn’t require deep cutting into the skin, nor stitches to close the wound. The area beneath the mole is anesthetized with lidocaine and the mole is then shaved off with a scalpel, leaving a smooth area where it had been previously.
The wound resulting from a shave removal is similar to a scratch and can be left to heal by itself. The normal skin around the wound supplies new cells to cover the wound's surface, which heals in approximately seven to 10 days. The wound should be kept clean and covered with a small sterile bandage. However, because moles have roots beneath the surface of the skin, there is a possibility of a recurrence and the mole may grow back.
Complete mole excision removes the mole entirely, including the root. The incision is then sutured. Only complete excision ensures the entire base of the mole is removed so any chance of recurrence is eliminated. However, a small scar may result. Experienced plastic surgeons and dermatologists can perform the procedure and use very small stitches to close the incision, ultimately leaving minimal scarring at the excision site.
Cryotherapy represents another option of removing skin lesions. Cryotherapy uses liquid nitrogen to freeze sunspots (solar keratoses), skin tags or superficial skin cancers. It is not used for true moles, as they cannot be effectively removed with cryotherapy, but in some cases, what appears to be a mole is actually seborrheic keratosis, which responds very well to freezing treatment.
I suggest that you schedule an appointment with an experienced facial plastic surgeon or dermatologist. He or she will be able to discuss the options with you so you can select the procedure that helps you to best achieve a beautiful cosmetic outcome.
First and foremost, it is extremely important that you avoid any of the various forms of snake oil being sold on the Internet. These include so-called home remedies like castor oil, apple cider vinegar, hydrogen peroxide, baking soda, tea tree oil, etc.
But it is also important to avoid laser mole removal on the face, or any method that removes mole tissue, without allowing for a lab to confirm it’s not a malignant melanoma (skin cancer).
The easiest way to find out which technique will be best for you is to schedule a consultation with a qualified, experienced dermatologist who ideally specializes in mole removal.
Complete excision is the best method. Removing moles through complete removal provides the best potential for accurate diagnosis. Treating a facial mole through shaving or “scalpel sculpting” has an extremely high recurrence rate. If the mole is simply shaved it may grow back.
Another factor that should be considered is the possibility that there is skin cancer. By using the shaving technique the doctor risks leaving behind a malignant portion of the mole.
There will be a facial mole removal scar if you choose to go with complete removal, but avoiding skin cancer is reason enough to have the entire mole removed.
The best method of facial mole removal is shaving it through a method called scalpel sculpting. This technique does not require deep incisions and avoids the need for stitches. Moreover, while all procedures involving incisions inevitably entail some level of scarring, the scalpel sculpting method of face mole removal has a much lower incidence of scarring when compared to other facial mole removal surgery techniques.
Scalpel sculpting is a straightforward procedure. First, local anesthesia is applied to the area beneath the mole. The dermatologist, facial plastic surgeon or plastic surgeon then uses a scalpel to remove the part of the mole that stands out from the surface of the skin. The mole should be flush with the rest of the skin surface after facial mole removal with scalpel sculpting.
The portion of the mole that has been removed is then sent to a lab to make sure it isn’t malignant.
After the procedure the surrounding skin will generate fresh cells to heal the wound, which should take about a week or two. In the meantime, patients are advised to apply ointment and a bandage while the wound heals.
Since most skin moles have a root beneath the skin’s surface, there is a chance that the mole will recur. However, this can be easily treated.
Scalpel sculpting is also preferable in terms of cost. The cost of facial mole removal can be higher with other techniques.
Thank you for sharing your question. If the mole is shaved, it will most likely grow back, and you will have a circular scar. If you have the mole excised entirely, the scar will look like a fine line. You wouldn't have to worry about it growing back if you decide to have it removed entirely. Your best bet is to have a Board Certified Plastic Surgeon remove it. I hope this was helpful to you.
Best Wishes, Dr. B.
Any removal that involves cutting will leave some type of scar. Shaving the mole will leave it flat, but the pigment will most likely still be there. If the mole is excised you will have a straight line scar. If you're willing to accept an incision line instead of the mole, then you might be a good candidate for removal.
-Lauren, Patient Coordinator