Mole Biopsy & Removal

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Mole Biopsy & Removal

_http://www.karlloren.com/biopsy/p26.htm_

(http://www.karlloren.com/biopsy/p26.htm)

 

Most 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, whi

ch 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.

(http://www.skincancerinfo.com/sectionf/11p.html)

(http://www.skincancerinfo.com/sectionf/11p.html)

(http://www.skincancerinfo.com/sectionf/11p.html)

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.