Cosmetic mole removal is used when people do not like the appearance of a mole on their face or body and would like it removed for cosmetic purposes only.
It is not performed to assess if a lesion is malignant, or to lower the risk of skin cancer later on in life. It can only be performed when moles are not suspicious looking because biopsies are not undertaken by a pathologist after removal of the lesion.
If a mole has any characteristics that suggest it could possibly be malignant or cancerous, then the doctor will elect not to do a cosmetic mole removal procedure, but rather an excision biopsy involving stitches and pathological analysis of the mole after it has been surgically removed. This often leaves a significant scar.
Cosmetic mole removal is performed using a radio frequency diathermy machine. This is a machine which basically vaporizes the lesion away until it is flat with the rest of the skin. This procedure creates a small raw wound, similar to a cigarette burn, which usually heals over the ensuing 10 to 14. Larger lesions, especially on the back, can take three weeks.
During this time it is essential to keep the wound ‘moist’, which simply means keeping the wound covered with either a dressing or barrier cream and not letting it ‘dry out’.
“Moist wound healing” accelerates the rate of healing and improves the final cosmetic result. Gone are the days when Grandma used to recommend that wounds should be dried out, exposed to the sun and the surf and that a disinfectant should be applied. Nowadays it is best to merely cover the wound with a waterproof dressing until the lesion is fully healed.
If the wound is allowed to dry out, a ‘scab’ commonly forms and is often picked off. The wound takes much longer to heal, becomes deeper and is more likely to scar.
With moist wound healing there is often a whitish exudate or covering on top of the wound which many people misinterpret as a wound infection, however this whitish coating on top of the lesion is normal. Only take the dressing off when you need to replace it. There is no need to perform daily dressing changes. Please do not use disinfectant to clean the wound. This can damage the delicate healing new cells.
Dressings can be cut down to a small size to ensure a better cosmetic effect during the healing phase. Even transparent dressings such as ‘Opsite’ or ‘Tegaderm’ can be used as well and small squares of the transparent dressing can be cut down to size and applied to the skin. This can appear like a small square of ‘glad wrap’ when applied to the skin. Another recent wound healing dressing development is silicon dressing tape which, while a little more expensive than standard dressings, may provide a better cosmetic result.
If it is embarrassing to wear a dressing out and about on your face, or if you have an important meeting to attend, you can apply a barrier cream such as Paw Paw Ointment, zinc cream or Vaseline to the small wound with a cotton wool bud and reapply this every two hours or so to ensure that the wound is kept clean at all times. Or you can use spray on liquid bandaids, such as ‘Opsite Spray’ applied two to three times a day to the treated lesion. This may sting a little bit when applied. Do not let the wound dry out otherwise the healing process will be delayed. Try to leave a dressing on at all times if at all possible and especially when you get home and overnight. Do not remove the band aid or dressing when showering.
The risk of infection is minimal with respect to mole removal and quite usual to occur.
Bleeding can occur after cosmetic mole removal and if this does occur, maintain constant firm pressure for 2 to 5 minutes after and this will usually stop the bleeding.
Once the lesion is healed, usually around two weeks, you can see that the skin is intact over the wound and there is a slight shininess to the surface of the skin. In other words there are no raw areas to the wound.
After this time, it is excellent to apply a Silicone dressing or gel to the wound to decrease the risk of scarring. Some people prefer to use Bio oil or Vitamin E lotion after the lesion has healed, however clinical evidence does suggest that the best treatment is silicone gel or silicondressings. This can be purchased at our clinic or at a Chemist. Common brands which are used include Kelocote or Dermatrix. This has been shown in numerous studies to reduce the risk of scarring and is commonly used after surgical procedures. This can be used for weeks to months after your treatment, according to how diligent you are at applying it and how much you want to reduce the risk of scarring yourself. Massage this onto the healed wound twice a day to lower the risk of the lesion raising up slightly into a small mound.
It is important for the first three months after removal of the mole that you minimize your exposure to the sun or UV rays.
There is a risk that pigmentation in the mole may reoccur if pigment cells lurk below the surface of the skin where the mole has been removed. These can reoccur 6 to 8 weeks after the procedure. Initially you think that there is no pigmentation left, however sometimes some pigmentation does reoccur after this time around the two month mark. This has a tendency to occur in darker skinned people and in darker moles.
It is an unfortunate occurrence which is not due to an error in removing the mole but is due to the fact that the pigment cells do occur in some instances below the surface of the skin.
Sometimes a revision a couple of months later can remove this pigmentation and we perform this procedure when it is requested at half the cost of mole removal.
In some darker skinned people, there is a significant risk of what is also called “post inflammatory hyperpigmentation”. This is where the UV rays can stimulate the pigment cells or “melanocytes” to become overactive. An example of ‘post inflammatory hyperpigmentation’ is commonly seen in darker complexioned people with acne. The pimple may disappear however for months to even years later, a darker spot can be seen on the skin where the pimple was.
After the mole has been removed, there is naturally a risk of scarring. The scar is usually minimal however and usually considerably less than if the mole had been removed with the conventional technique of using a scalpel and stitches.
You may see the skin texture is different in the area where the mole has been removed and often it is slightly lighter in colour than the surrounding skin due to the reduction in the number of pigment cells in the lower levels of the skin. Usually this change in skin texture is far less obvious than a darker raised mole which many people find unsightly and embarrassing.
In rare situations, a patient may be prone to hypertrophic scarring or keloid scarring. This is unpredictable however there is often a previous history of this occurring with previous trauma.
The wound, like any healing lesion, is usually pinkish for 6 to 8 weeks after the cosmetic mole removal and then this settles down. In people with reddish complexions this pinkish inflammatory response can persist for longer than a couple of months.
Massaging the healed lesion lowers the risk of the wound rising up into a small mound which can occur with the subclinical scarring reaction and collagen being deposited in the healing site.
Massage alone, even without the silicon gel, can lower the risk of this happening and can help flatten a raised lesion. Some people think this is the mole reoccurring but it is the body’s natural occasional reaction to inflammation and healing.
This all sounds complicated but the summary is, keep the wound covered with a dressing until it is healed, and then keep it protected from the sun for three months. Massage a silicon dressing onto it for weeks to months after and you will get the best cosmetic result possible out of your cosmetic mole removal.