The mole is first measured, mapped, and photographed during a skin exam. Your provider will sterilize the mole and surrounding skin with alcohol, then numb the area with local anesthesia. The injection may burn a little, but that’s the only discomfort you should feel during this procedure. You may also feel a little pressure. Overall, it doesn’t hurt.
The procedure can take anywhere from a few minutes to an hour, depending on the size of the mole and removal technique.Â
The method used will depend on the purpose of the removal, the mole’s color (brown, red or “nevi,” or black), the size, whether it’s raised or flat, and where it’s located.
Punch excision is often used for flat moles. A sharp cylindrical device (like a tiny cookie cutter) removes a round plug of tissue, including the mole. “Most flat moles can be punched out and allowed to heal on their own, if they’re tiny (1 mm) or they can be sutured closed, if they’re 2 mm or bigger,” says Dr. Hansen. Â
Shave excision (shave removal) works well for raised, light-colored moles. “If a mole is flesh-colored, it’s usually shaved flat,” says Dr. Hansen. “There’s a fifty-fifty chance of it growing back in several years.” The doctor will usually remove the outermost layers of the mole using a razor or scalpel, but the depth of surgical shave depends on the location and purpose of the removal. The area will bleed but won’t require stitches. With a small bandage, the area should heal quickly.Â
Surgical excision is often done if a mole is dark, bumpy, or potentially cancerous. Your doctor uses a scalpel to cut the mole and a border surrounding it in an elliptical (oval) shape. Then the skin is sewn back together, leaving a thin scar.Â
To minimize scarring, Dr. Hansen says, “I always feather out the edges of the incision just before I suture the wound closed and again, about three months later, to help blend and hide the scar.” Â
Of all methods of removal, surgical excision is the most cost effective with the least amount of post-operative hypopigmentation, according to a 2018 study in the Journal of Maxillofacial & Oral Surgery. For these reasons, it’s the most popular choice.
Mohs surgery is another method of surgical excision, done specifically for skin cancer lesions. This in-office procedure allows for immediate biopsy and diagnosis until margins are clear (e.g., no more melanoma is present).