Mole Was Removed but Scar Now Has Streaking Pigment?

The shave excision that was performed to remove your pigmented mole was not deep enough to remove all of the pigmented cells. Some of the deepest pigmented cells were left behind, and have now gone on to form additional pigment in the scar that remains. Even though pigment at these types of post-operative sites may look very abnormal, the pigment itself is not concerning unless the initial mole was cancerous or atypical.

The raised scar is a hypertrophic scar that has resulted from delayed healing following the shave excision. In an attempt to remove the entire depth of the lesion with a shave excision, your dermatologist likely performed a rather deep shave into the skin. This deeper wound takes longer to heal and results in more scarring. It is not uncommon for a deep shave excision to heal with a raised thick scar, a depressed thin scar, some form of pink coloration to the scar, and/or even some hypopigmentation of the site. The anatomic location of the shave excision may affect the appearance of the  scar as well since areas like the shoulders, back, and chest are notorious for less than optimal scarring. A full thickness excision with suture closure offers a superior result many times.

You wrote “the results came back not benign.” I’m not sure if this is a typo, or if the mole did demonstrate abnormalities. If the mole was atypical or cancerous then definitive full-thickness excision (with suture closure) of this residual pigment and scar is required. If the mole was benign, full-thickness excision and closure is still the treatment necessary to remove the scar and provide a satisfactory result.

Your plastic surgeon will be able to manage this for you based upon the histopathology of the shaved specimen.
Best wishes, Ken Dembny

A shave biopsy will not remove your mole. It is the less likely to do that. For removal, surgical excision of the mole is the best way to remove it and to get a diagnosis.

You say that the original lesion was "not benign." Does that mean it was atypical or does that mean it was malignant? In either event if you've developed pigmentation in a scar of a "not benign" pigmented lesion, it should be surgically removed. Recurrence of pigmentation after a shave biopsy is not unusual and is one of the risks of shave removal rather than excision and closure. If the lesion is benign, frequently no further surgery is necessary (it depends on what the pathology report says and the appearance of the pigmentation and the doctor's opinion). If the lesion was a malignant melanoma or even an atypical nevus (mole), it should be excised to assure that it is not malignant. Talk to your dermatologist and the plastic surgeon to determine what is necessary. Good luck.