Mole removal

1. 01

   Dermoscopy first, then the plan

   The mole is examined under dermoscopy before anything is decided, because how deep the pigment sits and how ordered its pattern looks are what choose the method — a raised, plainly benign mole suits a shave, while anything with an irregular network is taken full-thickness so the pathologist sees the whole lesion. The plan is settled in front of you, at the skin, not booked in advance from a photograph.

2. 02

   Numbing the site

   The area is numbed with a topical agent and then injected local anaesthetic, usually with adrenaline, which narrows the small vessels so the field stays dry and the block lasts through the removal. The injection stings for a few seconds; after that the removal itself should be felt as pressure and nothing more. You stay awake, and you can drive yourself home.

3. 03

   The mole comes off

   A shave excision passes a blade tangentially through the lesion and takes it off flush with the surrounding skin, which gives the better contour on raised moles. A punch or elliptical excision instead removes the full thickness of skin with a narrow margin of normal tissue around it — the choice whenever the lesion needs a definitive answer rather than a tidy result. One lesion takes 15 to 30 minutes.

4. 04

   Sealing or closing the wound

   A shave base is sealed with electrocautery or a chemical haemostatic and left to heal open, which is why it leaves a flat pale circle rather than a line. An excision is closed with sutures placed along the skin's relaxed tension lines, because a scar that runs with the natural creases is pulled on least and stays narrowest.

5. 05

   The specimen goes to the laboratory

   The tissue is labelled at the treatment couch, fixed, and sent to a pathologist who examines it for atypical or cancerous cells. This is the step that outlasts your trip: reporting takes several working days, so ask in which language the report is written and for the block and slide accession numbers, which let your own dermatologist request a second review anywhere in the world.

1. Day 1

   The dressing comes off the day after. From then on the wound is washed gently with mild fragrance-free soap, patted dry, covered with petroleum jelly from a squeeze tube and re-dressed daily — we skip antibiotic ointment, because contact allergy to it is a likelier problem than infection. Stinging or burning at the site is expected; most people are back at work the same day.

2. Week 1

   Shave and punch wounds close over at 7 to 10 days, and facial sutures come out at 5 to 7. This is the window in which anything wrong declares itself: pain should be fading, not building, and spreading redness, thick yellow discharge or fever means messaging us with photographs rather than waiting it out. Showering is fine with a fresh dressing after; nothing submerged.

3. Weeks 2–3

   Sutures on the trunk and limbs come out at 10 to 14 days, usually at home, so arrange that before you travel. Once the wound is closed — commonly 1 to 2 weeks — pools and hot tubs are back on. Strenuous exercise waits until the sutures are out if the site was a mobile, high-tension one such as the shoulder, back or knee, since pulling on a fresh line is what widens a scar.

4. Months 1–3

   The site is healed and covered in new skin that looks pink or red — this is the scar at its most obvious, not its final state. Broad-spectrum SPF 30 or higher over it every day genuinely changes the outcome, because fresh scar tissue darkens with sun and post-inflammatory pigmentation is slow to fade, more so in darker phototypes.

5. 6 months

   If pigment is going to return in a shave-excision scar it typically shows around now, averaging about five and a half months — the recurrent naevus phenomenon, and a reason to have any new colour looked at rather than assumed benign. Pigment spreading beyond the scar border is the finding that matters most.

6. 12 months

   Redness and firmness have settled and the scar has reached its final appearance. What you can see at a year is what you keep.

Every operation carries risk. We name them so you can ask the right questions.

• A scar at every removal site, including hypertrophic or keloid scarring, which is more common on the chest, shoulders and upper back. Scarring is certain rather than possible — the only question is how visible it is.
• Bleeding during the procedure or in the first 24 hours, made more likely by anticoagulant and antiplatelet medication.
• Wound infection, running at roughly 1 to 2% in dermatologic surgery without prophylactic antibiotics, higher below the knee and lower on the face. It shows as increasing pain, spreading redness or warmth, pus, yellow crusting or fever.
• Incomplete removal, with residual dermal melanocytes repigmenting the scar — the recurrent naevus phenomenon. Histologically confirmed recurrence or persistence after shave removal of mildly atypical dysplastic naevi is around 10% at 2 years, averaging 5.5 months to appear, and is strongly associated with the lesion extending to the lateral or follicular margins of the original specimen. The regrowth can mimic melanoma closely enough to need re-excision to tell them apart.
• A delayed or missed skin cancer diagnosis when a lesion is destroyed without histopathology, or removed with an unapproved at-home product.
• Post-inflammatory hyperpigmentation or hypopigmentation at the treated site, more pronounced in darker skin phototypes, and, rarely, injury to a superficial cutaneous nerve leaving altered sensation.