Moles: Causes and Removal

— Caycee, Alaska

There are several ways to remove a mole, depending on its size, location, and appearance. Your first step should be to visit a dermatologist who can examine your mole and determine whether it needs to be removed for health reasons. If there are any suspicious changes, your doctor may recommend a skin biopsy, which involves removing the entire mole (or a piece of it) and sending it to a lab to be tested for skin cancer. In general, moles that have been there for years without any change in their size or appearance are less likely to be dangerous. These benign (harmless) moles may be removed for cosmetic reasons, however.

If your mole is raised, there are two ways of removing it. Smaller moles can be removed by a method called shave removal. After numbing the area with a local anesthetic injection, the doctor uses a surgical blade to shave off the raised portion. No stitches are required, and the skin heals over in a week or two. Sometimes moles that are shaved off can grow back, although there is no way to predict whether this will happen. Also, if the mole has hairs, the hairs often grow back, even if the mole doesn’t. Removing the mole does not make it grow back larger, nor does it make it more likely to develop into skin cancer.

If you want to be certain that the mole does not grow back, the doctor needs to do an excision. In this method, the entire mole and its roots are cut out, and the surrounding skin is stitched together. Larger moles may require this type of removal.

Flat, brown moles may be treated with a laser, which uses a specific type of light to break up the pigment. Certain types of moles can also be treated by spraying or dabbing them with liquid nitrogen, which freezes them off. Both of these methods usually cause the mole to scab and fall off in one to two weeks, although the treatment may need to be repeated if the mole doesn’t fall off completely, or if it grows back.

With any type of mole removal, there is the possibility of leaving a scar. Smaller moles usually heal more quickly and leave less of a scar than larger ones. Also, certain individuals can develop “keloid” scars, which are thick, raised scars that can itch and grow. This is more common on the shoulders and upper trunk. Your dermatologist can discuss which mole removal method would work best for you and leave you with the best cosmetic results.

Q2. I have a mole on my face that started as a small freckle. It has grown to the size of an M&M. It has been that way for 15 years and has remained flat but a little crusty. In the last two or three weeks, another growth has erupted from it that looks like a wart. What could be happening here?

A changing mole should definitely be brought to your doctor's attention. While it's normal to develop new growths as we get older, a recent change in a mole's appearance, such as darkening in color or rapid growth, or new symptoms, like itching or bleeding, could indicate that it's turning into a skin cancer. Your doctor may recommend a skin biopsy to remove the growth and send it to the lab to find out what it is. This is a fairly simple procedure that can be done in the office under local anesthesia (similar to the numbing you get at the dentist). Most dermatologists are capable of removing an M&M-sized mole on the face with little risk of scarring. If the mole is in a tricky area, such as the nostril or near the eye, or if it is deep and requires many stitches, you may need to have a plastic surgeon perform the procedure.

One skin cancer that can look like a wart is called a "keratoacanthoma." This is a type of squamous cell skin cancer that typically grows rapidly, over the course of a few weeks, and is thought to be related to previous sun exposure. Keratoacanthoma is a relatively low-grade type of skin cancer, and the cure rate is very high as long as it's detected and treated early.

Although warts occur more frequently in children, they can occur in adults as well, especially if they had warts when they were younger. A more common growth in adults is a benign (harmless) lesion called a "seborrheic keratosis," which can look crusty and become more raised over time. These range in color from light gray-brown to dark brown, and typically have a rough surface. Occasionally one of these growths can become inflamed, either from rubbing on clothing or if it gets scratched. If your growth turns out to be an inflamed seborrheic keratosis, your dermatologist can use a liquid nitrogen spray to remove it.

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I recommend making an appointment with your dermatologist, who can determine what type of growth you have and whether it needs to be removed. In addition, it's a good idea for everyone to have a complete body examination at least once a year, to find and remove any suspicious growths.

Q3. My skin is very oily, and my pores look larger than normal. What can I do to smooth out my skin?

— Marisol, California

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