Options for Removing a Flat Mole on my Eyelid?

Scalpel Sculpting is the use of a scalpel to literally "sculpt" a growth (moles, keratoses, warts, etc.) off the skin flush with the surface of the surrounding skin. The procedure usually takes under five minutes and performed following the injection of a small amount local anesthesia instilled directly under the growth to numb the area. With smaller lesions, this procedure alone is often sufficient to achieve gratifying results and to obtain enough of the surface portion of the growth to send off as a biopsy (just to be a 1000% sure that we are not dealing with a skin malignancy masquerading as a benign  growth--as occasionally may happen). The procedure requires no deep cutting nor stitches.

In my over thirty years of experience, larger pigmented growths (those around the size of a pencil eraser--as this appears to be) often leave a rim of pigmented tissue after scalpel sculpting. Here's where dermaplaning comes in. Dermaplaning is the use of the edge of the scalpel blade--held at an angle--to "scrape" or "sand" away any remaining protrusion or rim of pigmented tissue. The result: a flat wound that heals with temporary crust formation and ultimately fades down to normal or near normal skin color as tissue from the surrounding normal skin grows in to cover and resurface the treated area. 

I would highly recommend that you see a board certified facial plastic surgeon or an oculoplastic surgeon for an evaluation and possible treatment.

I would excise the mole and dermabrade the edges to give the best cosmetic results.  Cost is estimated at $500 under local anesthesia with no down time and is easy to undergo.  Sincerely,

David Hansen,MD

First, the mole" from this picture looks like a "seborrheic keratosis", which is a benign growth that sits on the surface of the skin and does not require a deep excision. The diagnosis can usually easily be made by a dermatologist. If it's a melanocytic mole, a deeper excision would be required

An excision could make some changes to your eyelid if done incorrectly. The best way to lay the excision would be perpendicular to the eyelid. It could also affect your eyebrow.  laser excision could limit the area but the mole could come back. Then it would require another lasering to remove again. This is something to think about. 

First off, if the lesion is changing (i.e. bigger, darker, raised, itching, etc), it should be evaluated by a dermatologist. Also if the lesion has any of the features of melanoma it should be evaluated by a dermatologist. ABCD stands for Asymmetry, irregular Border, varied Color, and large Diameter. If it is suspicious for melanoma (and you can't tell without an in-office evaluation), it should be removed or at least a portion of it should be sampled. Since the pigmented lesion is flat, shave or tangential excision will not work as well as excision to the subcutaneous tissue. The lesion would have to be excised, and the repair would be dependent upon the size of the lesion and possible adjacent loose tissue. Based on the photograph, a flap repair would be more likely as a side-to-side repair would likely distort the free margin of the eyelid. I would recommend that you see either a fellowship-trained Mohs surgeon, plastic surgeon or oculoplastic surgeon. Talk to the doctor about their experience in surgery and repair in this area.

The best choice for removal of your mole is a careful cosmetic excision.  This will completely remove the mole. The eyelid responds well to a careful cosmetic excision with sutures or tissue glue and the mole will be gone forever.  Lasers, shave excision and other destructive methods will not do as well.

Based on the appearance of the mole I would recommend a consultation with a plastic surgeon to surgically remove the mole. Even though it appears flat, there is a component that is deeper under the skin that would need to be completely removed to avoid a recurrence.

Moles are quickly and easily removed by one of two methods: a shave excision or an excision with suture closure. Because of the size and location of your mole, it should be removed by excising a simple ellipse of skin. I then use a "layer closure" using both dissolving and non-dissolving sutures to give the best cosmetic result. The area then typically heals with a small, linear scar that is hardly visible.