Mole Removal: Information & Doctors for Mole Removal

Moles are medically referred to as nevi or, colloquially, as “leberflecken.” They are benign changes in normal skin. They develop from the skin’s pigment cells. Their color can range from light to almost black. It is important to distinguish between benign moles and malignant skin tumors, as well as moles that may require further diagnostic testing and treatment.

Moles are often hereditary. Almost everyone has a few moles. People with more than 50 moles have a slightly increased risk of developing skin cancer.

Medically, a wide variety of different types of moles and their subgroups are distinguished:

• Melanocytic nevi (e.g., freckles, café-au-lait spots)
• Nevoid nevi (e.g., hairy giant pigmented nevus)
• Epidermal nevi
• Sebaceous nevi (nevus sebaceus)
• Vascular nevi and hemangiomas (port-wine stains and hemangiomas)

People often have their moles removed for cosmetic reasons.

Removal is medically necessary if a birthmark is at risk of becoming malignant and developing into a melanoma. For example, it is recommended that

• to have suspicious moles checked regularly or
• to remove nevus cell nevi larger than 2 cm before the age of 20.

In general, you should have

• particularly large,
• unusually shaped, or
• discolored

moles. Some people choose to have a mole removed if they find it bothersome—for example, due to friction from clothing or for cosmetic reasons. In other cases, doctors may recommend removal as a precaution if a definitive diagnosis cannot be made without a biopsy.

Surgical removal of a mole is always preferable to alternative treatments.

Ideally, the decision to remove a mole should be made by a dermatologist. Small moles can usually be surgically removed without any problems under local anesthesia. The procedure takes only a few minutes. During the procedure, the mole is usually removed completely with a scalpel, along with its entire base, to allow for a thorough examination and to prevent regrowth.

For larger skin lesions, especially on the face, a specialist in plastic and aesthetic surgery should be consulted. This specialist can safely remove the mole while paying special attention to aesthetic considerations. Otherwise, even the removal of a small mole can leave a scar.

The wound is closed by repositioning the surrounding skin. Especially in cases of unclear or conspicuous findings, doctors may recommend removal and histological examination to reliably distinguish benign from malignant lesions.

For very large lesions, serial excision is often used. This involves multiple procedures in which a small portion of the nevus is removed each time. The surrounding skin is thus stretched and removed bit by bit.

The use of a skin expander is also an option. In this procedure, a plastic bag with a valve is inserted under the adjacent healthy skin through an incision. After healing, the bag can be filled with saline solution at regular intervals via the valve. This gently stretches the overlying skin.

Once sufficient stretching has been achieved, the bag and the nevus are removed in a second procedure. The defect is then closed using the stretched skin.

Depending on the complexity of the surgical procedure, all standard anesthesia methods are used:

• local anesthesia,
• a combination using twilight sedation, or
• general anesthesia.

With local anesthesia, the patient can return home shortly after the procedure, accompanied by someone. For the more complex procedures mentioned above, a short hospital stay is to be expected.

Laser treatment is also among the methods used for removal. In this procedure, the pigmented tissue is destroyed by targeted light pulses, allowing the mole to be removed without the need for a surgical incision.

However, this method is not suitable for all skin lesions. In particular, laser treatment should not be performed if skin cancer is suspected, as the tissue removed by the laser is not fully available for histological examination. Therefore, surgical intervention is generally preferred for suspicious moles to ensure a definitive diagnosis.

The laser method can be used primarily for clearly benign and superficial skin lesions, although a prior examination by a dermatologist is required in these cases as well.

No surgery is without risks! However, in the hands of a specially trained specialist, the surgical and anesthesiological risks are very low.

Rare surgical risks include

• postoperative bleeding,
• infections,
• impaired wound healing, and
• prominent scarring

.
In rare cases, infections or wound healing complications may also occur, but these are usually easily treatable.

Scar immediately after the removal of a small birthmark © Carola Vahldiek | AdobeStock

After the removal of small nevi, only a wound check and the removal of the sutures are necessary. Depending on the location of the mole and the healing process, the sutures are removed after 5 to 14 days. Surgical removal is performed in such a way that the tissue is completely excised and can be sent for histological examination to confirm the diagnosis.

The process is different for larger procedures, particularly after the use of a skin expander. Regular checkups, combined with refilling the expander, should take place. It can sometimes take several weeks to months to achieve the desired volume and skin stretching.

If a birthmark is removed for medical reasons, the costs are covered by health insurance.

If a mole is removed for purely cosmetic reasons, the patient must cover the costs themselves.

The risks associated with mole removal can be minimized when the procedure is performed by a properly trained specialist.

The removal of a “normal” mole is a quick, straightforward procedure. If there is a certain risk of malignancy, the procedure should definitely be performed. The decision to undergo surgery is always based on an individual medical assessment of the risk and the clinical presentation.