Should moderate atypical moles be excised after shave biopsy?

Mole removal begins with a comprehensive examination and consultation to determine the likelihood of a mole being worrisome. Excisional and incisional biopsies are reserved for suspicious moles. But it’s good news that most moles are not problematic and are only cosmetic, thus leading to the option of scarless or non-surgical mole removal with lasers and RF and plasma. Our office specializes in non-surgical mole removal.

Best,
Dr. Raffy Karamanoukian
Realself 100 Surgeon

Thank you for your question.

When a mole is diagnosed as moderately atypical and the margins are clear (negative) following a shave biopsy, the decision to excise more tissue often depends on several factors, including personal risk tolerance, family history of melanoma, and dermatologic guidelines.

Here’s what to consider:

Clear Margins: If the pathologist confirms that the atypical cells do not extend to the edges of the biopsy, many dermatologists do not recommend re-excision. The risk of recurrence or progression to melanoma in moderate atypia with negative margins is considered low.

If Margins Were Positive: If atypical cells extended to the edge (positive margins), a narrow-margin excision is often advised to reduce the risk of recurrence.

Patient Risk Factors: If you have a personal or family history of melanoma, a large number of atypical moles, or immunosuppression, excision might be more strongly considered.

Monitoring Option: If you opt not to excise further, close clinical follow-up and monitoring of the area for any signs of regrowth or changes is essential.

Ultimately, either approach — observation with regular skin checks or re-excision — is considered acceptable, and the decision can be made based on your comfort level with monitoring vs. proactively removing the area.

Let me know if you’d like to understand the pros and cons in more detail.