Facial Mole Removal : Here’s What You Need To Know

General

Undergoing facial mole removal can be a scary and intimidating process. After all, it’s your face! The right amount of knowledge lets you know what to expect and can help put your mind at ease, so if you’re considering a facial mole removal procedure, read on. In this article, we’ll cover all the major topics you’ll need to know about this big decision.

Benign Versus Abnormal Facial Moles:

One of the very first things your doctor will consider when you’re seen for a facial mole removal consultation is whether the mole appears totally safe or has suspicious features.

Benign Facial Moles

Benign moles are composed of mole cells (melanocytes) that are normal and can be removed with a wide variety of both surgical and non-surgical techniques. On the other hand, abnormal facial moles nearly always require surgical facial mole removal. Benign moles have relatively uniform color, borders, and are symmetric. Here are a few examples of benign facial moles:

Abnormal Moles:

Abnormal moles can be either pre-cancerous or cancerous, also described as “pre-malignant” and “malignant”. Non-cancerous are commonly referred to as dysplastic moles meaning that the cells that constitute the mole are showing some features of changing from benign to cancerous, but haven’t yet “crossed the line”. Abnormal moles that are cancerous, are known as melanoma, a serious form of skin cancer. If a mole shows any suspicious signs of being pre-cancerous or cancerous it will require surgical facial mole removal techniques to remove it to obtain a lab analysis that provides critical information about the mole. Surgical procedures are needed in these cases because other techniques such as laser and freezing destroy the mole tissue too much for it to be analyzed accurately.

Very dark irregular mole that is a melanoma skin cancer
A dark, irregular mole that is a melanoma skin cancer (©ScarScore Inc.)

Is A Facial Mole Biopsy Necessary?

Many doctors agree that all moles being removed should also undergo a laboratory analysis to determine with certainty if it is benign, pre-cancerous, or cancerous. If a mole is removed but doesn’t also undergo a biopsy, there is a chance that it harboured undetected pre-cancerous or even cancerous changes that will never be identified. This could put a patient at significant health risk down the road. That said, there are very reputable health care practitioners that do not believe that totally benign-looking facial moles require a biopsy, so it’s a point worth discussing with your doctor.

IF YOU’RE HAVING A FACIAL MOLE REMOVAL TALK TO YOUR DOCTOR ABOUT THE NEED FOR A BIOPSY

You May Need More Than One Procedure:

Some situations call for removing a small sample of the facial mole for biopsy (called an “incisional biopsy”) and only proceeding with complete facial mole removal once the biopsy results are back from the lab. An initial biopsy may be needed:

  • to prove a suspicious-looking facial mole is benign and safe to leave in place if the patient prefers not to have the mole removed
  • to prove the mole is benign before using techniques such as laser, or electrosurgery that should not be used on abnormal moles.

Preparing For Facial Mole Removal:

Almost all facial mole removal procedures are done under local anesthesia (freezing needle) on an out-patient basis. The procedure typically takes about 20-30 minutes and is done in an office/clinic setting or a hospital’s minor surgery department. Minimal preparation is needed for these procedures, but a few points to keep in mind include:

Steps Involved With The Facial Mole Removal Procedure:

The basic steps involved with a facial mole removal procedure are:

  • local anesthesia injection into the area of the facial mole(s)
  • the facial mole removal procedure
  • tidying up of the skin and application of ointments and/or bandages
  • discharge home with after-care instructions

Cosmetic Facial Mole Removal Techniques:

Cosmetic facial mole removal refers to the removal of benign moles with the primary focus on aesthetics and minimal scarring. This can differ from abnormal mole excision which prioritizes other issues such as removing additional skin around the mole. There are several popular options for cosmetic mole removal depending on factors including the location of the mole on the body, it’s size, and whether it sits flush with the skin or protrudes above the skin level.

Shave And Curette Excision

Shave excisions are a minimally invasive surgical technique done under local anesthesia, usually chosen for smaller moles than protrude above the skin level. The mole is shaved off at the skin level using a blade passed across the base of the mole leaving a wound resembling a rug burn that heals on its own, usually over 7-14 days. A variation of shave excisions is a curetting procedure which uses a scoop-shaped surgical blade to remove the facial mole. Shaves are usually not chosen for facial moles that have deeper “roots” into the skin’s dermis because shaving these could be a setup for poor scarring.

ProsCons
can heal beautifully with very minimal visible scarring when performed technically wellcan be prone to slow healing and poor scarring if done too deeply into the skin
heal more as a blemish than a true scarhealed area may be lighter or darker than surrounding skin
less activity restrictions during recovery, mostly because no stitches used that could openhigher recurrence rates than deeper excisions
allows for biopsy lab analysismay not be appropriate for biopsies of suspected abnormal facial moles
Scar from shave of a facial mole
Blemish-like mark left by facial mole removal done by shave excision technique (photo taken 6 months after procedure) (©ScarScore Inc.)

Deep Excision With Stitching

Facial mole removal by excision with sutures involves deeper surgical removal than shave excisions. The incisions can be made using a standard surgical scalp or a circular blade called a punch biopsy tool. Because the procedure cuts deeper into the skin, stitches help to avoid a prolonged healing time, “indented” contour, and heavy scarring.

ProsCons
stitching narrows the wound to a fine-line configurationalways forms a scar, the quality of which is very individualized
lowest recurrence rate due to deeper facial mole removalmore activity restrictions during recovery, mostly because stitches could open
allows for complete biopsy analysisrequires a stitch removal appointment for non-dissolving stitches
scar from facial mole excision
Good quality linear scar after facial mole removal by excision and stitching (photo taken 6 months after procedure) (©ScarScore Inc.)

Ablation Techniques

Ablation techniques of facial mole removal are procedures that destroy the mole on the surface of the skin instead of surgically removing it. Popular ablative techniques include laser, liquid nitrogen (freezing), electrodessication (burning), and radio-frequency. Because ablative facial mole removal destroys the mole, it leaves no useful tissue for a biopsy analysis to be performed on, so a surgical biopsy that removes some of the mole surgically is necessary if a lab analysis is needed.

Abnormal Facial Mole Removal Techniques:

Abnormal mole removal (pre-cancerous and cancerous moles) procedures are done surgically – either shave excisions, curetting, or excision with sutures. The primary reason for this is that with pre-cancerous or cancerous facial moles, a lab analysis that can only be done with an intact facial mole specimen is required. Ablation techniques like laser, freezing, and burning the mole off the skin destroy the tissue beyond the labs ability to analyze it accurately. The lab analysis provides vital pieces of information including details regarding the invasiveness of an abnormal or cancerous mole as well as an assessment on whether the procedure achieved complete removal of the mole on the microscopic level (referred to as “clear margins”).

Mole in a biopsy bottle
Biopsies need surgical techniques so the mole can be sent intact and undamaged to the lab (©ScarScore Inc.)

An abnormal facial mole is generally removed with an additional cuff of skin around the edges (referred to as a “margin”). Doing this helps to ensure that the abnormal mole cells are completely eradicated from the skin, but also has the effect of increasing the overall size of the scar that forms.

Excision of an abnormal facial mole showing surgical margins
Abnormal facial moles, like this cheek melanoma, are removed with extra skin (blue lines) to eliminate all possible cancer cells (©ScarScore Inc.)

Facial Mole Removal After Care and Follow-Up:

Different facial mole removal techniques involve different after care instructions. For example, shave excision and excision with sutures are dealt with somewhat differently. Also, different doctors tend to have slightly different protocols. Most clinics will provide verbal and written explanations of best aftercare practices but some common instructions after facial mole removal include:

  • keeping the area dry for about 24-48 hours
  • avoiding immersion of your face in water for 10-14 days
  • being cautious or avoiding strenuous work and exercise for about a week

If non-dissolvable stitches are used for the procedure, you will need a follow up to have them removed. This will be scheduled for anywhere between 5-10 days after the procedure. Other follow-up visits, such as for bandage changes or routine wound care, will be determined by your doctor’s preferred routines and protocols.

Potential Facial Mole Removal Complications:

Problems that you may encounter in the week or two after a facial mole removal include:

  • infection (rare with facial mole removal)
  • bleeding from the wound
  • opening of a stitched wound before it is fully healed

Longer term issues include:

  • facial mole recurrence
  • pigmentary changes (lighter or darker than surrounding skin)
  • unsatisfactory scarring
Hypertrophic scar from facial mole removal
Thick, hypertrophic type scarring resulting from a facial mole removal procedure (©ScarScore Inc.)

Scars From Mole Removal:

There is no such thing as scarless facial mole removal. Any technique that removes a mole will also leave a scar, the only question is: what will the final scar look like? Smaller moles will obviously leave smaller scars than much larger ones, but the length of a scar is only one feature that determines overall scar visibility. Other characteristsics such as discoloration, width and thickness all contribute to the overall quality of the final scar. To learn more about scars from mole removal, have a look at our article on scarring.

Do Moles Grow Back?

Like any surgical procedure, facial mole removal is not foolproof. Depending on the type of mole removed and the technique used to remove it, the possibility that facial moles grow back (referred to as “recurrence rates”) can vary from near zero up to 10% or more. Situations can arise in which a balance is struck between choosing a less invasive facial mole removal technique, in exchange for what may be a higher recurrence rate. A common example of this is the choice to use a shave excision approach to facial mole removal due to it’s potential to heal with nearly no visible scarring while knowing that with shave excisions, facial moles grow back more frequently than with excision and stitching procedures.

LESS INVASIVE FACIAL MOLE REMOVAL PROCEDURES MAY HAVE HIGHER A RECURRENCE RATE THAN MORE INVASIVE METHODS

Facial Mole Removal Cost:

Facial mole removal being done solely for cosmetic reasons is usually paid out-of-pocket by the patient. According to The HealthCare Bluebook, facial mole removal cost range in the USA varies with the size of the mole, with approximate fees being:

size of facial moleprice range
very small$250 – $800
small$320 – $1100
moderate$420 – $1350
large$750 – $2300
Approximate average fees for various-size moles

Conclusion:

Getting rid of that mole you cringe at seeing in pictures or selfies can do a lot for your self-confidence and can be achieved through a relatively minor procedure with minimal recovery. Abnormal facial mole removal can be a life-saving procedure in the case of pre-cancerous moles and melanoma skin cancers. For cosmetic facial mole removal, success of the procedure is mostly dependent on healing with inconspicuous, good quality scars.

Medical References:

Clinical, cosmetic and investigational dermatology vol. 7 89-103. 19 Mar. 2014, doi:10.2147/CCID.S57782

Rosendahl CO, Grant-Kels JM, Que SK. Dysplastic nevus: Fact and fiction. J Am Acad Dermatol. 2015 Sep;73(3):507-12. doi: 10.1016/j.jaad.2015.04.029. Epub 2015 May 30. PMID: 26037217.

Sardana, Kabir et al. “Optimal management of common acquired melanocytic nevi (moles): current perspectives.” .

Zalaudek I, Docimo G, Argenziano G. Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi. Arch Dermatol. 2009 Jul;145(7):816-26. doi: 10.1001/archdermatol.2009.115. PMID: 19620566; PMCID: PMC2856040.

Niamtu J 3rd. Esthetic removal of head and neck nevi and lesions with 4.0-MHz radio-wave surgery: a 30-year experience. J Oral Maxillofac Surg. 2014 Jun;72(6):1139-50. doi: 10.1016/j.joms.2013.10.015. Epub 2013 Oct 31. PMID: 24388180.

Hocutt JE Jr. Skin cryosurgery for the family physician. Am Fam Physician. 1993 Sep 1;48(3):445-52, 455-6. PMID: 8155114.

Chopra A, Sharma R, Rao UNM. Pathology of Melanoma. Surg Clin North Am. 2020 Feb;100(1):43-59. doi: 10.1016/j.suc.2019.09.004. Epub 2019 Oct 29. PMID: 31753115.

Soft tissue lesions.in: Sauer G.C. Hall J.C. Manual of Skin Diseases (ed 7). Lippincott-Raven, Philadelphia, PA 1998: 338-342

Silverstein D, Mariwalla K. Biopsy of the pigmented lesions. Dermatol Clin. 2012 Jul;30(3):435-43. doi: 10.1016/j.det.2012.04.013. PMID: 22800550.

Iyengar S, Yeager DG, Cohen JL, Ozog DM. Update and Review of Bleeding Considerations in Dermatologic Surgery: Anticoagulants and Antiplatelets. Dermatol Surg. 2020 Feb;46(2):192-201. doi: 10.1097/DSS.0000000000002266. PMID: 31743247.

Arguello-Guerra L, Vargas-Chandomid E, Díaz-González JM, Méndez-Flores S, Ruelas-Villavicencio A, Domínguez-Cherit J. Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/o

Reddy Bandral, Manjunatha et al. “A Comparative Evaluation of Surgical, Electrosurgery and Diode Laser in the Management of Maxillofacial Nevus.” Journal of maxillofacial and oral surgery vol. 17,4 (2018): 547-556. doi:10.1007/s12663-018-1081-8

The content (text, graphics, images, and all other materials) provided throughout this website is informational in nature only and does not constitute medical advice. The content provided on this website is not intended as a substitute for professional medical advice. Any questions you have regarding any medical condition, treatment, intervention, pharmaceutical, vitamin, supplement, or other should be addressed with a qualified healthcare practitioner. ScarScore Inc. makes no guarantees whatsoever on the safety or efficacy of any of the treatments, products, or other medical interventions described on this website. Health conditions and drug information contained in the content of this website are subject to change and are not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. ScarScore Inc. does not endorse any test, healthcare practitioner, product, procedure, opinion, service, or other information that is described in the content of this website.