I would recommend that you have this lesion treated by shave excision and sent to pathology. With this procedure, your hair will stay intact. Since the lesion is changing and sometimes painful, your insurance should cover the procedure.
Mole Removal on the Scalp
A mole of the type you describe (skin colored, mushroom shape, traumatized by grooming) is usually best treated by shave excision on the scalp. No hair needs to be shaved. It's a simple, short procedure. If the dermatologist feels that there are some atypical features to this mole when they examine you, they might recommend excision and suturing, but most likely shave excision will suffice. Since the mole is symptomatic and changing, your insurance should cover its removal, but of course, each person's insurance is unique and you'll have to discuss that with your physician.
Best Methods of Mole Removal
The good news is that typically when I remove scalp nevi (moles) I will usually use a "shave excision" method. The mole is actually "shaved off" at a level just below the surface of the skin. This method is quite effective to remove moles and leaves a minimal scar. No hair is removed or destroyed. The procedure typically takes less than a minute, and is fairly painless. Moles that are removed in this fashion will rarely recur enough to be bothersome. If they do, they can always be excised and sutured at that time, but this rarely happens. It is also usually covered by insurance. I would NOT recommend consulting a board certified plastic surgeon (as recommended below) as they rarely do shave excisions.
Dermatologists often see moles on scalp that are traumatized by hair brushing etc.. Depending on the appearance of the mole, also called a nevus, the dermatologist can decide whether it should be removed deeply with stitches, or simply by a more shallow shave to remove the part that sticks out and gets traumatized. Either way, the tissue removed is sent to a pathologist to make sure it is completely benign. Generally, unless the lesion is very suspicious, no hair needs to be shaved. Almost always, it is covered by insurance. Make sure you comfirm this with the physician prior to removal.
Hope that helps.
Madeline Krauss, M.D.
In order to remove a mole completely, an excision that includes the deeper portions of the skin needs to be performed. Taking a mole off the surface of the skin may not remove the entire lesion and it may recur. For an excision, a small area surrounding the mole would need to be shaved so that the wound dressing can be applied after the surgery.
The question is also why the mole is tender. Is it because you are traumatizing it when brushing or washing your hair? Or is it symptomatic by itself? A symptomatic mole needs to be sent to a pathologist to be examined under the microscope. In fact any removed mole needs to be sent to a pathologist to be examined.
Whether your insurance will cover it depends strictly on your insurance plan. Ask your benefits specialist.
Mole removal from the scalp does not need shaving of the hair. As for insurance coverage, that would depend on your insurance and specifics of the policy. check with your insurance. Consult a board certified plastic surgeon to get the best scar possible.