Moles are benign skin lesions and usually they are pigmented. They are also called naevii and they may present on any part of the body or face.
They can have a variety of shapes, sizes and shades. Typically they are round in shape and brown in colour. They can be flat or protruding. Those present at birth are known as congenital naevii; more often they appear as we age.
The vast majority of moles do not cause any medical harm but there are a number of situations when one should consider removal. Any new mole that has suddenly appeared or one that has started to become darker or has had a shape change needs to be reviewed by a clinician well experienced in the management of pigmented lesions. A mole which bleeds or ulcerates definitely needs to be checked out. Itching and irritation are relative indications for examination. If in doubt the suspicious mole should be biopsied to confirm its nature. Rarely some individuals suffer from multiple moles all over their trunk and limbs. These individuals do need regular “mole checks” to monitor for suspicious moles that should be biopsied.
The only definitive reason to excise a mole is if there is suspicion that it is in fact a cancer such as a melanoma or has transformed into one.
Other indications for removing a mole are those, which are genuinely irritating or are a nuisance. Moles near the eye in the field of vision, cause discomfort or itch should be considered for excision. Probably the most common reason for removing a mole is cosmetic. In most cases this will leave a scar but some superficial lesions such as basal cell papillomas can be shaved off. Using this technique a well-healed scar-less result can be achieved. However most moles will need excision otherwise recurrence can occur. It requires some experience to decide whether the cosmetic appearance of the resulting scar would be better than the mole itself. The size of the mole, its anatomical location and the direction of the resultant scar are all important factors in deciding whether surgery is the correct cosmetic option. Some areas such as the shoulder, back and the central part of the chest tend to scar less well than the face or the hand. Interestingly, older people on the whole scar much better than young people and certain races with darker skin may have a tendency to thick scars called keloids. Surgical technique is also a very significant factor in outcome. As mentioned, the direction of the scar is very important. It should be designed to lie in the natural line of the deep collagen fibres of the skin and also within creases and shadows if possible.
Removal of moles can be carried out under local anaesthetic. This will involve injection of local anaesthetic with a very thin syringe needle so it should not cause too much discomfort. If a single or only a few moles are removed, time off work or normal activity will not be necessary. Fine sutures or special tapes are usually used to close the wound and these are removed between five and seven days after the surgery. Special instructions will be given to makes sure the wound is well looked after to ensure satisfactory maturation into a pale thin scar that should hopefully be difficult to see at conversational distance. This should be the ultimate aim of treatment.