When is a Spot More than a Cosmetic Concern?

Many people have skin spots that they don’t like. These spots could be a mole on the face, a birthmark on the body, or something more worrisome, like skin cancer, or a pre-cancerous growth. These may be new or irregular growths. During this crisis, it can be hard for patients to know what to do if they or a loved one discovers a spot of concern.

How is a spot diagnosed?

At the time of examination, I assess the patient’s spot of concern. Often, the spot has been evaluated by another dermatologist who has determined it is benign. However, I will always re-evaluate the spot when I see a patient (whether in person or, for now, virtually). If it looks entirely benign, then we will proceed with a cosmetic evaluation. If I have any concerns about the spot, we will discuss medical options for monitoring or diagnosing the growth.

When should I be concerned about a spot?

Spots to be concerned about have one or more of the following features:

• a new irregular, unusual or symptomatic growth
• a spot that is bleeding, scabbing, won’t heal
• a spot that is growing rapidly
• a brown spot that is growing, changing or looks irregular (remember the ABCDEs of concerning moles).

One of the best ways for my skin cancer patients to stay healthy is to get their regular skin cancer screening visits every three, six, or twelve months, as appropriate. Unfortunately, the COVID crisis has interrupted these follow up appointments as we try to keep patients, families, and staff safe over the following weeks and months.

During this crisis, how do I seek medical advice?

At APDerm, we are using teledermatology as a bridge during this crisis until we can resume all necessary dermatology care. It is a way to evaluate worrisome spots and see if coming in for an urgent visit makes sense or to judge whether the spot can wait for weeks or even a couple of months.

Patients with a history of skin cancer should have a heightened awareness of concerning spots when their regular visit is delayed. If you fall into this group and you have a concerning spot, we can arrange a teledermatology visit for you to assess whether an urgent appointment and biopsy are needed. Just call the office (978) 707-6208 or fill out the form below, and our staff will walk you through the process.

Once the results of a biopsy are known, we can determine the best course of action in the short term. Most melanomas and squamous cell carcinomas should be treated within 6 weeks of diagnosis, if possible. Basal cell carcinomas (the most common skin cancer), can be safely pushed off for several months during the current crisis, if necessary.

What are my options for a non-cancerous spot removal?

Removal Options

For cosmetic growths, there are usually two options. A mole or growth can be removed with a shaving procedure. This is intended to get the growth out of the way, and thus it works better for raised growths, which can be shaved down flat to the surface of the skin. However, it often does not remove the entire growth (i.e., the roots), so there may be regrowth in the future. As far as scarring, any removal leaves a scar, though it is often subtle. The goal is for the scar to be more pleasing to you than the aggravating aspects of the growth. A flat scar that results from a shaving procedure may be flesh-colored, white, pink, or sometimes brown. If a mole is removed, it actually can have more pigment at the base than on the surface, and it can leave a darker “beauty mark” behind. In my experience, most shave removals leave a subtle scar that is considerably less noticeable than the growth that was removed.

A deeper and more aggressive approach to removal is called an excision. The growth or spot is cut out with a scalpel through the thickness of the skin. Usually, a diamond shape piece is removed around and including the growth. This allows for the edges of the skin to be brought together smoothly in a line of stitches. There are typically underneath stitches that dissolve over two or three months and outside stitches that are removed in one to two weeks. The result is a fine line scar. This scar is always longer than you would imagine, typically three to four times as long as the growth is wide, due to the physics of pulling the skin together. The goal is to make the scar as subtle as possible, but that scar will always be with you, and there are no “scarless” excisions.

Which option is best?

A shave technique works best for smaller, raised growths. There is minimal downtime after a shave removal, and it falls into the category of “you can always do more, but you can never do less,” which is often the right approach for small undesirable growths.

An excision is much more involved than a shaving procedure, and there are 1-2 weeks required downtime from activities. There are surgical risks, including bleeding, infection, pain, and poor scar healing. The surgical site takes several months to settle down and look its best. And, scar remodeling and improvement from an excision can take 3, 6, 12 or even 18 months to reach its final improvement.

I typically recommend excision if a small growth has come back multiple times; if the growth is flat and unsightly and a linear scar is preferred; or for larger growths on the body where, again, a scar is preferred to a dark or noticeable growth.

Should I have it removed?

I am often asked, “should I do it?” If there is any medical concern about the growth, we will do what is best medically. That can be an advantage of seeing a dermatologist for removal: we evaluate thousands of growths every year in our practices and have extensive experience determining which ones are concerning.

Cosmetically, you need to like the resulting scar more than the growth. Only you can make that decision, though I can help guide you by discussing likely results. Also, of course, this is a cosmetic removal not covered by insurance. Will you enjoy the outcome more than a new item or experience?

And remember, if the spot is catching your attention because it is growing, changing, or symptomatic, it could be the sign of medical concern and should be evaluated.

We are here to help you with all your dermatology needs during this crisis and after. Please reach out to us either calling (978) 707-6208.