Black Dot Appeared After Mole Removal

Question

About a month ago a dermatologist removed a colorless raised mole from my back, with a scalpel, when I requested. The mole was benign. Now a flat black dot has appeared where the mole was. The area has not been exposed to the sun and other than the dot it appears to be healing well. What could cause the appearance of pigmentation where none has ever been and is this something I should go get checked out?

Emily Altman, MD · Answer

Normal moles have a maturation process.  They start out as flat pigmented (brown or tan) spots, that eventually become raised and flesh-colored.  Trauma to the mole, such as a scratch or any surgery, can stimulate the melanocytes (cells that make up the mole) to produce pigment again.

Raised benign moles usually have two components: one above the skin surface and one below.  When a mole is shaved off the surface of the skin, the deeper component remains.  The removal itself stimulates the melanocytes to produce pigment again.  This is what accounts for the black spots in the scar as the mole grows back.  It may not raise again but the pigment does come back.

What is important is to know that the mole was benign on biopsy.  If it is then the recurrence is not important.  If the mole had some abnormalities, it's recommended to have the rest of the recurrent mole removed.  

In order to make sure any mole is completely removed, both the superficial and deeper component need to be removed such as with a punch biopsy and stitches.

Philip Young, MD · Answer

This is likely a recurrence of the mole. If it was removed with a scalpel, the question is how it was done. Was the mole shaved off or excised by cutting it out? If it was shaved the recurrence is very high, almost guaranteed. The recurrence can even occur with excision. It depends on how much of a margin you take with the mole sometimes as well.  If you the margins are 3 mm the recurrence is low teens, 4mm high single digits, 5mm lower single digits, percentage wise.

T. Wayne Day, MD · Answer

The good news is that the lab test showed the mole was benign. That being the case you don't need to do anything. Over the next year you should expect the darkness to fade naturally.

	What may have caused this to happen? Even flesh colored moles have pigment cells. When the top is removed the root of the mole below is triggered to try to re-grow another mole. Since it can't, the pigment production is the best it can do.

Mitchell Schwartz, MD - Account Suspended · Answer

An small, central area of hyperpigmentation is common after a shave excision. This is because the mole is actually "shaved off" at a level just below the surface of the skin. If the biopsy results show it to be cancerous or pre-cancerous then a second step, a complete excision with uninvolved margins, is necessary to ensure its complete removal. The mole will rarely regrow and the appearance with the central dark spot should not be objectionable. If the black dot grows larger in the future, please use the ABCDE's as your guide for when to be concerned: Asymmetry; Irregular Borders; black or uneven Colors; Diameter greater than a pencil eraser; and a growth that is Evolving or changing.

Black Dot Appeared After Mole Removal

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Black Dot Appeared After Mole Removal

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Everything you need to know about Mole Removal

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