In many cases, the doctor will use a technique called incisional biopsy, which means taking a piece of tissue smaller than the mole to determine whether the growth is benign (noncancerous) or malignant (cancerous). Incisional biopsy techniques include punching with a miniature cookie-cutter-like instrument, shaving with a sharp scalpel and snipping with scissors. In many cases, these biopsies are completed in less than a minute and require no suture (stitch) removal. All of these techniques leave some mole cells in the skin. Less than 10% of the time, these remaining cells will regrow into a new mole, called a nevus recurrens that may be darker than the original mole. In most cases, the wound heals within 2 - 3 weeks as a flat scar (approximately the same size as the original mole) that fades over time. Using sunscreen with an SPF of 15 or higher on a regular basis can minimize darkening of the scar.
After removal, samples of the tissue are sent to a pathology lab for biopsy, or analysis under a microscope. If the biopsy indicates the presence of cancerous cells, the doctor may then do a margin excision to remove any remaining mole. This technique includes the removal of normal (margin) tissue around the mole. With a margin excision on the body, the doctor may use subcuticular (below the skin) sutures. With a margin excision on the face, the doctor may use a combination of extremely fine sutures on the surface and absorbable sutures under the skin.
In other cases, a doctor may perform an excisional biopsy instead of the combination of incisional biopsy plus margin excision. With an excisional biopsy, an entire mole as well as the normal tissue around it is removed in the hopes of removing both the mole and any cells, which may be spreading but are invisible to the naked eye. Both margin excisions and excisional biopsies result in larger scars than incisional biopsies.
Please note that it is recommended that all moles, even benign-looking ones, be sent to a pathology lab for analysis under a microscope. In many cases, even 'harmless' moles have turned out to be cancerous.
Many doctors prefer to remove moles with lasers instead of scalpels. Because lasers seal blood vessels as they cut the tissue, the need for sutures is eliminated, which reduces scarring. After the surgery, a scab forms and falls off within 5-14 days. Once the scab is gone, the remaining slight redness will eventually disappear as well.
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