Skin mole removal

FAQs

Will it hurt?

Not usually. Skin mole removal is a very straightforward procedure. The most you should feel is the first poke of a very thin needle. I inject the local anaesthetic really slowly so it doesn’t hurt or sting. This numbs the area around the mole or lump, which allows me to do the surgery without causing you pain. You may be aware of a mild pushing or pulling sensation, but most patients aren’t bothered by this and sometimes fall asleep in the middle of surgery!

Will there be a scar?

Whenever the full thickness of the skin is injured or incised, there is always a scar and scars are permanent. Even having a blood test causes a scar at the puncture site, but it may be so small that it is difficult to see – and that is the key point: plastic surgeons are experts at creating scars that are difficult to see.

Anyone who says they can remove a mole from the deep layers of the skin with ‘scarless healing’ is either having you on or is a time traveller from the future when we have discovered how to truly achieve scarless healing. Scraping a mole off the surface layers of the skin, or burning it off with a laser, is sometimes called ‘scarless healing’, but these superficial wounds were never going to cause a scar in any case.

Only injury to the deeper layers of the skin causes a scar, and sometimes this is necessary to remove all of a deep mole or a lump under the skin.

What will the scar look like?

This depends on many factors:

• Differences between individuals’ scarring tendencies, which we cannot predict.

There may be a genetic predisposition to poor scarring.

• The type of skin and location on the body.

In general, oily or pigmented skin produce more obvious scars. The shoulder and middle of the chest often produce unfavourable scars.

• The amount of tension on the wound closure.

  One advantage of ageing is that wrinkles make scars less prone to widening due to the increased slack in the skin. I can also plan to hide a scar within the depths of a wrinkle.

• The direction of the wound.

  There are well-known tension lines in the skin – scars are generally planned to lie parallel with these lines for the best results.

• The condition of the patient and the wound.

  General conditions such as diabetes, rheumatoid, poor nutrition, and smoking can affect wound healing. Certain medications, such as high-dose steroids and other immune suppressant drugs, can also delay healing and increase the risk of infection.

• Surgical technique.

  It goes without saying that perfect tissue handling and stitching are important, but I have put it at the bottom of this list because scar formation is unpredictable even with meticulous technique.

How long does it take the scar to settle?

Scars take around 18 – 24 months to fully mature, during which time the scar changes from a thin pencil-line in the first week to a thicker, raised red scar over the next few months. It is impossible for scars to disappear – they just get fainter with time.

Regular firm massage of the scar with a simple moisturiser helps scar pliability and decreases scar sensitivity. Protecting the scar from the sun helps avoid pigment changes in the scar, that may be permanent and make it more obvious.

Gradually, the redness and bulk of the scar diminishes and you are hopefully left with a thin, flat scar that is a similar colour to the surrounding skin.

What if I get a bad scar?

The causes of excessive scar formation are not well-understood. There are two main types of bad scars:

• Hypertrophic scars

These are limited to the original wound margins and usually occur within 8 weeks of surgery. They can grow rapidly into a lumpy, raised, thick scar over the course of 6 months. It can take a number of years for the scar to flatten.

• Keloid scars

Keloids are less common and are more likely to occur in people with dark skin. They may run in families and can become painful, sensitive and itchy. They do not tend to settle on their own and can spread beyond the margins of the original wound.

Some bad scars can be improved with scar revision surgery, but the risk and benefits of intervening and restarting the scarring process need to be carefully considered.