If a growth of the skin has been present for many years and lacks the characteristics of cancerous skin lesions (see section on skin cancers) then both the patient and surgeon can feel comfortable that it is benign and can be removed with a simple excision. With such a situation, the decision to remove the skin lesion or mole is purely cosmetic. It is important for the patient to understand that the mole still needs to be removed by making an incision through the skin, which will result in a scar. In fact, all incisions heal with some type of scar. Techniques can be employed by the surgeon to make the scar as discreet as possible. Ultimately, the patient will ask the surgeon if the existing mole or the potential resulting scar is more noticeable. Often the answer is that the resulting scar will be less noticeable than the mole.
Benign moles are often less than 1 centimeter in diameter and can therefore be removed with a simple excision and closure. The excision is typically designed in the shape of an ellipse so that the tapered ends can be closed without the skin edges bunching up. Such gathering of the skin is often called a standing ear deformity or “dog ear”. If the mole is located near a natural skin crease or fold, then the resulting scar will be harder to see and will therefore be less noticeable. The challenge occurs when the mole is located in an “open” area such as the middle of the cheek, forehead or nose. In such situations, minimizing the appearance of the scar depends on the orientation of the scar relative to the natural skin lines and closure technique. The face has natural skin lines that run in different directions depending on the location. The scar can be designed to lie parallel to such natural skin lines, also known as relaxed skin tension lines, in order to appear as natural creases. The closure must be performed in meticulous fashion by making the skin edges match perfectly and with slight eversion (turned out) so that with healing the scar lies flat. The skin edges are typically closed with “permanent” stitches that will need to be removed after 5-7 days. Occasionally the deeper skin levels will be closed first with a dissolvable stitch.
While the stitches are in place, non-reactive ointment is applied twice daily to promote wound healing. Rarely, over the counter pain medication is necessary. Once the stitches are removed, it is important to protect the wound from sun exposure as it can become hyperpigmented. Often the suture line will be slightly irregular and red. This typically dissipates over several weeks. Whereas the vast majority of the healing occurs within 2-3 weeks, as with any wound the healing process does not fully mature for 10-12 months.