I have two "fleshy" moles on my face, and I've heard that laser procedure can remove them. I have been to two doctors; and one wanted to "shave" them off, the other wants to have them "cut". I'm confused--which of these techniques should I choose? Since it's my face, I don't want to risk getting the wrong procedure.
Laser Treatment for "Fleshy" Facial Mole Removal
Doctor Answers 19
2 surgical ways to remove a mole
In general, dermatologists surgically remove moles in one of two ways, shaving or cutting.
Shave excision, or tangential excision, is fast, easy, and leaves almost no mark. It involves using a scalpel blade horizontal to the skin and shaving 'the top' off of the mole. Generally, a scab will form for about 10days after this procedure, and then the mole appears to be gone. The trouble is, sometimes the mole recurs, as the 'roots' are still underneath the skin. Sometimes it doesn't recur at all, sometimes 10 years later, and sometimes a few months later. I would say at least half of the time, the mole does not recur. If it does recur, you could have it shaved off again, or have it 'cut' out.
To 'cut' out a mole usually refers to the method of cutting with the scalpel vertically into the skin to remove the whole depth of the mole, and suturing the sides together. This can be done with a minimal scar, but depending on the location and size of the mole, sometimes the scar is more noticeable. Done this way, the mole almost never recurs, given that it is removed in entirety.
I don't usually laser moles since it is safest to biopsy any mole that is removed and that can't be done if it is lasered off. Also either method of surgical removal usually gives an excellent cosmetic result.
Fleshy mole removal on the face: excision vs laser
Laser removal of a fleshy mole can only be accomplished by burning the mole off with an ablative laser. That would leave a flat scar the same size or larger than the mole on your face. That would most likely result in a less cosmetically acceptable or pleasing appearance than an excision with a scalpel and careful suturing, which should produce a thin, linear scar. Unfortunately there is no procedure that can remove a mole without leaving any scar.
However, there are ways to make a scar less obvious. Depending on where the mole is located, the excision of the mole can be placed in a natural skin relaxation line, which would make the scar less visible. The proper techniques for bringing the cut edges of the skin together also help to minimize the scar.
In addition, the care of wound after the procedure also plays a big role in making the scar much less noticeable.
It is often recommended to do a shave biopsy and then lasering the remaining portion of the mole to achieve a nice contour. By shaving the mole, there is a chance that the mole will return. The other options is to do a complete surgical excision of the mole in which you would be trading in the mole for a linear scar.
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"Shave removal" is the same as "cut".
Laser is not a good way to remove a true mole on the face. It is important to remove the tissue intact so it can be tested to be 100% sure it is not something bad. Careful, artistic shave removal (with a blade) can remove the mole at the base and make it flat. This often heals with very little scarring on the face. Sometimes a flat, small brown freckle may appear at the site. This is pigmented cells that were originally in the core, which are not dangerous, provided the pathology of the removed mole is benign.
"Excision" of the mole with stitches can leave a linear scar, but does remove the whole root. This is a choice to be made knowing all pros and cons and discussing with your doctor.
Laser for fleshy mole removal
It sounds as though shave biopsy or excisional biopsy was recommended for you- in both instances the moles should be sent to a pathologist for further examination. If the results show that they are benign the remainder of the mole/nevus cells can be removed in a cosmetically appropriate manner by your cosmetic physician.
Best way to remove moles
Lasering is not good for moles, not only because it doesn't allow the mole to be sent to the pathologist, but also it will tend to replace the mole with a round scar that is often a noticeably different color than the surrounding skin.
Regarding shave biopsy removal versus surgical excision, dermatologists treat a lot more moles than I do, but my bias as a plastic surgeon is to excise the mole, send it to pathology, and close it with fine sutures. The resulting scar tends to be much more discreet in my opinion, than a typical shave biopsy scar which tends to look like a white spot (I have one myself --next time, I will ask my dermatologist to cut it out and not shave it!)
Laser treatment of a mole
Moles are a general term for a growth on the skin, but often they are made up of non-cancerous pigment cells called melanocytes or nevocellular cells. The problem is that these same cells can sometimes be cancerous. We call this type of cancer melanoma. Melanomas are curable when found and treated early, but can be deadly when they are found at a later stage or when they spread to lymph nodes and internal organs.
When a mole is removed with a laser, the tissue is destroyed and cannot be examined to be sure that it is not a melanoma.
I generally excise moles on the face because I think the results are better than with shaving. The resulting scar is usually negligible. Also, when a mole is removed with shaving, there can be a depression at the wound, pigment can form at the base of the scar and the mole can recur.
What every you decide, don’t have your mole removed with a laser.
"Fleshy" moles and treatment
"Fleshy" moles are much better shaved off and not removed with laser. Lasers are amazing for many things but not for mole removals. It is not medically indicated. You need to have these moles sent to the pathology lab to confirm whether they are benign or malignant. Especially on the face, a shave removal will give you the best results. It is really important to seek out a board certified dermatologist with experience in cosmetic procedures for the best result.
Just have it cut off.
Despite the fact that lasers are heavily promoted, they do not always offer superior results. For a simple mole, surgical excision and closure usually yields better results.
John Di Saia, MD