I had a mole removed this past February. Melanoma runs in my family. It was a shave biopsy and the results came back as not benign. Recent I had a physical with my primary doctor and she referred me to a plastic surgeon as she is concerned about the 'streaking pigment' that has since showed up. The scar is also quite raised. Initial mole was removed by a dermatologist. If the plastic surgeon wants to remove more what can I expect? Is there a possibility it could still be cancerous?
Mole Was Removed but Scar Now Has Streaking Pigment?
Doctor Answers 4
Mole biopsy through shave biopsy
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.
Inadequate Shave Excision Results In Residual Pigment At Site Of Mole
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
Scar from mole removal with streaking pigment
You said the mole came back as "not benign" but did not specify exactly what it was. It is possible you have an atypical mole (which is not a cancer) but you should make certain the biopsy was read by a dermatopathologist. Streaking pigment most likely means that part of the mole is still remaining so it is important to know exactly what the biopsy report said. In our office, we will do an excision with suture closure to get clear margins for all moles that have moderate to severe atypia. For a mildly atypical mole we will observe the area and, if any pigmentation recurs in the biopsy site in the future, a very small excision is done (often with a small punch biopsy tool) for a minimal scar. We also follow all of our "atypical mole" patients by doing full skin examinations every six months. I recommend you see a board certified dermatologist who specializes in skin surgery for both your surgery options as well as your follow-up examinations twice yearly.
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Pigment after Mole Removal
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.