Mole/birthmark Removal, Should I Do It Surgically or with Electrocautery?

Dark Brown or Black Pigmented Birthmark removal
The best way to remove this would be direct excision with closure in such a way to leave a minimal scar. . Lasers are generally not used and it is customary to send what was removed to a pathologist for analysis to make sure it is not worrisome.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Complete surgical excision is recommended in this case.  It is advised to send the specimen to pathology for complete analysis to confirm whether it is benign or malignant.  With this procedure, you will be replacing the lesion with a linear scar.  

Thank you for your question
Judging by what i see on your picture I recommend you consult a Board certified plastic surgeon in your area for direct excision. But you need to be aware that the excision will leave a linear line.
Best Wishes
Dr Genevieve FCaron, Board Certified Plastic Surgeon
Montreal, Canada

Thank you for your question.  There are various ways to remove birthmarks, depending on its etiology.  For example, a birthmark caused due to a vascular problem needs a completely different treatment than a birthmark such as a mole.  More often than not, vascular birthmarks need to have some form of laser treatment.  They can require more, but a laser is generally a minimum.  Other birthmarks such as a mole, can be excised in the office with relative ease.  The size and location will determine the final outcome.  A photograph always helps but there is no substitute for and in person physical examination.  Make sure you visit with a board certified plastic surgeon for the best outcomes.

Surgical excision is recommended as this will produce a specimen for pathologic analysis and completely remove the lesion. The lesion will be replaced by a linear scar and a board certified plastic surgeon can use closure techniques to create the best possible scar. Full excision is covered by most insurance plans.

Surgery is definitely the preferred method to remove a mole (nevus) for two reasons.

One:  it works better cosmetically and Two: any mole removed should be sent for pathology to exlude cancer. 

A one centimeter mole is larger than usual and warrants pathologic exam - this should be covered by insurance.

Electrosurgical destruction will probably not completely remove it and will generate heat, causing longer healing and usually a less desirable scar.  

I have removed thousands of moles and am well versed in all removal techniques. 

The vast majority of moles/birthmarks tend to be benign.  A small portion may be malignant (ie, melanoma) or pre-malignant (ie, dysplastic nevus).  Although you would be trading your mole for a surgical scar, the major advantage would be complete excision of the birthmark so that there is no chance of developing a malignant, albeit rare, complication.  Also, you would be obtaining a firm diagnosis which offers peace of mind.  Depending on the source, there is approximately 1-10% risk of developing melanoma or other skin cancer in a given birthmark over a lifetime.  This can be a substantial risk for some individuals, who may wish to eliminate the worry from their lives.  Electrocautery would destroy the lesion but there are several disadvantages: 1) it may not destroy all microscopic elements of the birthmark, especially the deeper cells located along the hair follicles in the fat layer; 2) it will likely still leave a scar or indentation in the skin; and 3) you will not be able to get a diagnosis if the birthmark looks worrisome.  For these reasons, I routinely recommend surgical excision which more reliably addresses the problem and gives us a diagnosis.  It also allows the complete elimination of even the deeper parts of the birthmark that are located in the fat layer of skin and can be frequently missed by lasers or electrocautery.