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ABC of General Surgery

Moles and other Pigmented Skin Lesions

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 1. What is a Mole?
A "mole" or naevus (pronounced nee-vus) is an small area of skin that has more pigment in it than the surrounding skin.  Brown skin colour is caused by a chemical called melanin that is produced by cells in the skin called melanocytes.  Melanin protects the skin from the harmful components of sunlight (ultraviolet rays) which is why people who live in sunnier countries have darker skin.  Moles are normal.  Occasionally however, a growth can develop in the skin that may look very like a mole but which is in fact a small skin cancer.

2. What are the features of a skin cancer?
There are two main types of skin cancer:

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Squamous: which develops from the skin cells and is not usually a different colour from the skin.

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Melanoma: which

If skin cancers are picked up early, before they have chance to spread, they can be cured by simple surgical removal.  Skin cancers tend to develop on areas of skin that are regularly exposed to sunlight.  They appear as new lumps which start small and which grow in size.  Any skin lesion grows to more than 6 mm (1/4") should be considered suspicious.  Melanomas are usually dark in colour and may appear in a previous mole or on normal skin.  Any new, dark coloured skin lesion should be considered suspicious.  New skin lesions that itch, bleed or scab but don't heal up should be considered suspicious.  Skin cancers can occur in young people, especially in fair skinned people who have a lot of exposure to sun.

3. What will happen if I have a suspicious mole and I do nothing about it?
If the lesion is in fact a skin cancer it will grow and spread.  Skin cancer usually spreads through the lymph system and from there all over the body.  Uncontrolled spread of skin cancer is usually fatal.

4. What treatment is required for a suspicious mole?
The simplest answer is that all suspicious moles or skin lesions should be assessed by a specialist and removed for microscope examination.  Most turn out to be simple, benign moles.  Others are early skin cancers which are usually cured by this simple surgical removal.

5. What will happen if I need an operation on my suspicious mole?
Most lesions are less than 10 mm (3/8") and can usually be removed using just a local anaesthetic in your local hospital day surgery unit.  Larger lesions may require a biopsy first to diagnose the lesion and then definitive treatment based on the result.

6. What does the operation involve?
The operation involves making an incision in the skin, removing the lesion with a small amount of the normal surrounding tissue, then closing the incision with stitches.  Some surgeons use stitches that will dissolve in the body and do not need to be removed, others used stitches that are removed after the wound has healed (usually 1 to 3 weeks).  Your surgeon will discuss which method is appropriate before the operation..

7. How long does it take to recover?
Most patients find that about one week is required to recover fully after minor surgery but this depends on the site and size of the operation.  How long you stay off work is dependent on the type of work you do.

8. Will I need to come back to hospital after the operation?
Most specialists like to see the patient in the outpatient clinic after their operation to discuss the result of the biopsy and check that the wound has healed satisfactorily.  If the diagnosis is skin cancer then further investigations, treatment and follow up appointments may be necessary.

9. Will the operation cure all the symptoms?
Most patients are reassured by having the lump removed and have complete relief of their symptoms.  It is normal for a scar to remain at the site of the operation and this scar should fade progressively with time.  Most small skin cancers are cured by this simple surgery and do not come back.

12. Will the mole come back?
Benign moles do not come back but new ones may appear from time to time.  Skin cancers can come back which is why patients with skin cancer are usually followed up for a number of years after treatment.

S.R.Dodds 2006

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