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Mole Biopsy & Removal

Cancer & Biopsy

 

......ost people have moles in various numbers and locations. Moles are genetically determined in many cases and can thus be considered inherited to a certain extent. Reasons for removing a mole include suspicion of malignancy, irritation or a cosmetically unacceptable appearance. Medical insurance usually covers the removal in the first two situations.

......If a mole is changing or otherwise suspicious for malignancy, a biopsy should be performed. A biopsy is the removal of any size piece of tissue, large or small, and the analysis of the cells in a specially stained specimen under a microscope.

......There are many ways to biopsy a mole, each varying in cost and scar formation. The author is specially trained in all the existing forms of mole removal. The author's philosophy on mole removal is that, for initial testing, the removal of large pieces of margin (normal) tissue around moles, thereby leaving large scars, is NOT helpful. The extra normal tissue in a large excisional specimen makes it more difficult for the average laboratory to examine a mole thoroughly. FOR INITIAL EXAMINATION or biopsy, the author takes a tiny triangulate (inverted pryamidal) biopsy of small moles. Moles that protrude may delicately be sampled tangentially, i.e., removed to the level of the skin, which is then lightly sanded to match the surrounding body contours. Though the biopsy will be small, it will usually encompass a good portion (60-90%) of the mole cells making the growth. If the biopsy is read "benign," then no further work is necessary. If the biopsy indi-cates any potential for trouble in the future, then the patient will be advised of the options and a final decision made for or against a margin excision to remove any remaining mole.

......If the author must perform a margin excision on the face, ex-tremely fine (7-0) surface stitches and absorbable deep stitches are used so as to not leave "tracks." If the mole is on the body, the author usually uses subcuticular (below surface) stitches that never pass through the surface of the skin in order to avoid tracks.

......Is it dangerous to leave any part of a "bad mole" behind? Isn't it always better to sample moles with a margin excision to avoid spilling potentially malignant cells into the bloodstream? The answers are, fortunately, NO! British and American Dermatologists have battled over these questions for years; detailed studies of large and small melanoma biopsies have now been done that resoundingly favor the American view that small specimens are not dangerous. These studies have shown that melanoma sampled by small biopsies does not spread cells into the bloodstream to any greater degree than melanoma sampled by taking large-margin excisions. Melanoma is derived from cells similar to those of a mole. Melanoma is one of the deadliest forms of skin cancer. If melanoma is not spread from small samples, neither should small sampling a mole spread any possible abnormal cells.

......If a benign-looking, protruding mole needs to be removed due to irritation or to enhance cosmetic appearance, a technique called tangential incisional biopsy may be performed. This procedure consists of "shaving" the mole with a sharp scalpel parallel to the surface of the skin, followed by a light sanding. This biopsy removes the raised portion of the mole, leaving some mole cells in the skin. Less than 10% of the time, these remaining mole cells will regrow the mole; sometimes such regrowth will be even darker than the original mole prior to the biopsy. A tangential-incisional-biopsy wound generally heals within two to three weeks as a flat scar approximately the same size as the original mole. Initially, the scar can be pink, darker or lighter than the surrounding skin. This color tends to blend in with time so that cosmetic results are usually excellent, with a barely perceptible scar. Darkening of the site is minimized if the patient avoids sun exposure or uses at least a number 15 sunscreen on the area for several weeks after the biopsy. It is important to provide good wound care to the area for the best cosmetic result. See Wound Care.

......The healing tendency following tangential biopsies is unpredictable, depending greatly on the individual patient. Rarely, a raised or depressed scar may develop in spite of good biopsy technique and meticulous care. The best thing to do for cosmetic purposes, if one does not know one's healing tendency from previous wounds or surgery, is to have only one mole removed first to see how it heals before having multiple moles removed. Raised scars are more common on the trunk near the breastbone, so one must weigh the risk versus possible benefits there. If a raised scar does form, local steroid injections and firm deep massage are usually effective treatment.

......Again, all moles that are removed, even benign-looking ones, should be sent to pathology for microscopic examination. This examination helps to tell doctors whether the mole is harmless or whether the patient should have more bordering tissue removed. Sometimes moles that are textbook examples of benign or "good" moles turn out to be serious melanoma, discovered incidentally (by chance or by accident). This is because 10% of melanomas may not fit dermatologists' classic rules for malignancy. Since early detection and removal is the best way to cure melanoma, the patient can participate actively in his/her own care by self-examination. Signs of concern include a mole's recent change in appearance, size, shape or color, irregularity in color, loss of a uniform border, asymmetry (inequality on either side of a line drawn down the middle), bleeding or the notching of a border. Moles with any of these signs should be brought at once to the attention of a dermatologist for close examination.

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