Skin Moles

Skin moles can be surgically removed for cosmesis or biopsied because of concern regarding the cancerous potential of a mole. A skin biopsy can be performed simply in the doctor's office. Several techniques are practiced, and each has specific advantages. Pigmented lesions suspicious for melanoma should be removed completely. This is best done by complete excision. We only do shave biopsies on such lesions if we are certain that the deepest portion of the lesion will be removed. Both shave and punch biopsies result in a scar. Benign lesions are only removed if the patient understands that a permanent scar will result.

skin moles removed for cosmetic considerations are often removed by shave excision. Punch excision can be used for relatively small moles. Large moles may require complete excision with sutured closure, because moles exceeding 1 cm in diameter often are not amenable to the shave technique. A simple conservative excisional biopsy with a sutured closure is usually the most speedy means to diagnosis if concern exists regarding the possibility of melanoma. If the mole is found to be benign, then, ordinarily, no further treatment is required.

Providing the pathologist with a complete excisional specimen affords the best opportunity to make an accurate diagnosis because all available criteria (including gross features such as size, circumscription, and symmetry) can be applied to the mole. Interpreting partial biopsy samples of melanoma is not wise, especially for pathologists with limited experience in the microscopic evaluation of melanocytic neoplasms; not uncommonly, it can lead to a false diagnosis of a mole. If a biopsy specimen represents a partial sample of a larger mole, the clinician should clearly indicate this to the dermatopathologist or pathologist on the requisition form. If any atypical feature is present, a second opinion from an expert dermatopathologist should be pursued.