Jay S. Gottlieb, DO

Lesion number one---Don't do that again!!  There is no way to know if the mole was normal or dysplastic or a melanoma.  Most times a dermatologist can use a dermatoscope and evaluate the pigment pattern and determine if a biopsy is needed.  The problem here is that you have traumatized the base.  Even a normal mole can look abnormal under the microscope if it is traumatized.  The first step here is to see a board certified dermatologist and have him/her evaluate what is present now and determine if a biopsy is in order.  The cosmetic outcome would be of secondary concern if the dermatologist determines that a biopsy is needed.

When these cysts occur on the scalp, they are usually pilar cysts.  The originate from the pilar sheath that surrounds the hair shaft.  They are not dangerous and rarely get infected. They do have a tendency to grow and the pressure can cause hair loss around the cyst from the pressure that exerts on the surrounding hair follicles.  When they become infected, like it sounds yours has, they need to be treated.  The usually treatment is hot compresses and oral antibiotics.  Sometimes, if it forms an abscess, it needs to be drained.  After several week, then the cyst should be removed.  It is an office procedure that should cost less then $800 or so.  There may also be a charge of about $150 when from the pathologist.

There are a few factors that determine how good or bad a scar will look after it heals.  The size of the move being removed, the area that it is being removed from (areas with more motion tend not to heal as well), post operative care, how well the patient tends to heal and the expertise of the surgeon doing the procedure.  Although it is not fail proof, I would suggest that if the moles really bother you, take one off and give it 6 months to heal and see how it looks.  If you don't heal well, it is better to have one scar rather then six.  Also, remember, nobody ever asks you how you how you got your moles or even comment on them.  But people always seem to ask about scars.  Since this is being done purely for cosmetic reasons, it would be sad if you were less pleased with the scar then you were with the mole.

Absorbable sutures tend to absorb at different rates in different patients.  At four days it is unlikely that they are absorbing.  It is possible that the knot is just not holding.  I would suggest talking to your physician and see if he/she would like to steri-strip the wound for a little extra holding power.  I do not use absorbable sutures for skin closure in my office because of the unpredictable nature of the material and the fact that sometimes sutures need to be left in a little longer or a little less long depending on the patient and the location of the wound or excision.  It is my preference to use a permanent suture and then determine when the best time is to remove them.  I have had patients come in for suture removal at 7 days and elected to leave them in for a few more days.  Absorbable sutures do not give me that option.  Bottom-line, talk to your doctor.

Have your dermatologist see if you have urticaria (hives).  Unfortunately, it possible to have more then one skin condition at the same time.  If your dermatologist finds that you do, in fact, have urticaria then going on antihistamines may be of value to you.