When should a mole
be removed?

The ABCDE rule, which changes are a cause for concern and which are not, why every lesion removed is sent for histology, and why laser is not suitable for moles.

Everyone has moles, and the vast majority will never cause any problem in a lifetime. The question is not whether to have them all removed — you should not. The question is which ones deserve attention.

The ABCDE rule

This is the most widely used way of judging for yourself whether a lesion needs to be examined. It is not a diagnosis but a warning sign.

• A — Asymmetry. One half does not match the other
• B — Border. The edges are irregular, notched or blurred
• C — Colour. Several shades within one lesion, or areas of black, red or white
• D — Diameter. More than 6 millimetres, although size alone is not decisive
• E — Evolving. A change in size, shape, colour or sensation

Of the five, the last is the most important. A mole that is changing needs to be examined, however it looks on the other criteria. A mole that has stayed the same for twenty years usually does not.

Other reasons for removal

Not every removal is prompted by suspicion. There are perfectly good reasons to remove a benign lesion.

• It bleeds or becomes sore during everyday activities
• It is irritated by a bra strap, belt, shaving or jewellery
• It itches or hurts
• It is growing quickly
• It is somewhere you cannot keep an eye on — the back, the scalp
• It bothers you cosmetically

Mechanical irritation is an underrated reason. A lesion that is repeatedly knocked or rubbed is uncomfortable and becomes inflamed — that is reason enough, without looking for anything more.

Why histology is essential

Appearance is not a diagnosis. Dermoscopy helps and reduces uncertainty, but the only definitive answer comes from the microscope.

That is why every surgically removed pigmented or clinically suspicious lesion is sent for histological examination, however harmless it looks. The result is usually available within 7 to 14 days.

Why not laser?

A laser destroys the tissue. Afterwards, there is nothing left to examine.

With a pigmented lesion, this is a serious problem. If the mole was something more than a mole, you have no way of knowing — and because it has disappeared from view, there is nothing left to monitor either.

For non-pigmented skin growths — fibromas, some warts — laser is an acceptable option. For moles, surgical excision remains the right choice.

What the removal involves

A minor outpatient procedure under local anaesthesia. It takes between fifteen and forty minutes, depending on the number and size of the lesions.

The incision is planned along the natural skin lines so that the scar is as inconspicuous as possible. The wound is closed in layers, and the stitches either dissolve or are removed depending on the area — earlier on the face, later on the back and limbs.

Yes, there will be a scar. Every surgical excision leaves a mark. With good technique and aftercare, it becomes a thin, pale line.

What to do in the meantime

• Photograph any suspicious lesions with a ruler beside them, so you have something to compare against
• Get someone to help you check your back and scalp — that is where the lesions nobody notices are hiding
• Use sun protection all year round, not just in summer
• No sunbeds
• If you have had skin cancer, regular follow-up is not a formality

And the most practical advice of all: a mole you are wondering whether to show a doctor is already a mole you should show. The examination takes twenty minutes.