A small mole on my cheek was determined to be a melanocyte of moderate atypia. The dermatologist recommended that the rest be removed with a 2-3mm margin. Does it REALLT need to be removed when it will result in a scarring to my face? Are there alternatives for treatment that are not as invasive as excision? Is it possible to treat this mole through the use of lasers, localized radiation, or topical chemotherepy?
Can I Remove This Mole With Laser, Localized Radiation or Topical Chemotherapy? (photo)
Doctor Answers (4)
Can I Remove This Mole With Laser, Localized Radiation or Topical Chemotherapy?
As the initial pathology has returned with moderate atypia of melanocytes, the recommended treatment is to have a complete excision with an adequate clear margin. It is most important to ensure that all the abnormal cells are removed to ensure that it does not recur. With laser and localized radiation there will be no pathology specimen and hence you will not know if it is all removed. There is no topical chemotherapy that has been clinically proven to aid in the complete removal of atypical nevi.
If the mole was found to have moderate atypia, then it is often recommended that a complete surgical excision be performed. It is possible to get a great cosmetic outcome with surgical removal.
Watchful waiting is an option
Since atypical nevi are not cancer, there is no absolute requirement for surgical removal with margins. While complete removal is the cautious approach of many dermatologists, it is certainly reasonable to closely monitor the area when the mole is in a cosmetically sensitive area that is easy to watch. You need to discuss this with your dermatologist. Complete surgical removal, however, usually has excellent cosmetic outcomes and removes any risk of the atypical nevus evolving into a melanoma (which will need a much larger surgery for removal!). I absolutely discourage lasers, radiation, and topical chemotherapy. All of those options are inappropriate treatments for moles, and may cause more harm than good.
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How to remove a moderately atypical mole on the face
In our office, we will do an excision with suture closure to get clear margins for all moles that have moderate to severe atypia. Because of the size and location of your mole, it should be removed by excising a simple ellipse of skin. I then use a "layer closure" using both dissolving and non-dissolving sutures to give the best cosmetic result. The area then typically heals with a small, linear scar that is hardly visible.
You can follow the video link below to learn more about identifying the changes in moles that are suspicious for skin cancer.