Mole Removal Questions and Answers

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Question:

This is for Dr. Amy Taub, Reading about the melanoma Brian has. I want to know why all cover pages on melanoma say if caught early usually cured. My wonderful 37 yr olds son died June 14, 2001 after a 4 1/2 yr battle with melanoma. When mole removed .7 and no other treatment performed. Sample sent to PA and said came back clear. 1 1/2 years later to lymph nodes. Surgery and full year of interferon. No new signs until 2 yrs later rushed to hospital and found brain tumor. His mole was same as Brians but lower on the back. I believe the dye is new and wasn't available at the time of my sons mole removal but why is treatment done at mole removal. When my son told the admitting at St. Lukes in Milw. his story, she said if you knew how may times I heard that, said she thinks she would demand some other treatment at time of removal. I'm still searching for answers. He tried everything. Went to Burzynski Clinic in TX, called Bethesda, MD, saw a specialists in Chicago but all that was when it was spreading rapidly. Wish I knew if he had went to another Dr. first if it would have helped. Sorry this is long and maybe will never even get a reply. If I can get any answers, it will help me and the young couple will be in my prayers. My son left twin boys 12 yrs old. Thanks, Donna Smith

Answer:

Dear Donna, Please accept my condolences at your terrible loss. When you say no treatment, does this mean that the melanoma was never re-excised? Usually for .7 the mole would at least have been re-excised with a margin of normal skin and an excision that was fairly deep, ie all the way to the top of the muscles. Unfortunately, medical treatments are based on statistics and weighing the pluses and minuses. The statistics are that with a .7 deep melanoma, the odds were very positively in your son's favor (I'd have to know all the facts to run an "exact" odds estimate, but assume it was more than 80% chance of cure). But this doesn't help the folks like your son who was one of the unlucky ones. Let's say we had 10 men your son's age who had melanoma like his. 8 or 9 of them would probably be cured by re-excisional surgery alone. 1 or 2 would wind up having a metastatic lesion (as your son did) later. Do you think the other 8 or 9 should have to take interferon for a year with all the attendant side effects and the interference with daily life? From your perspective you might say yes, but from the other 8 or 9's view it would be no. So, typically, we go with the odds when they are as one-sided as this. With respect to the dye in the lymph node procedure, it still is not usually done for people who have thin melanomas (like your son's) unless there was something else in his history (it was ulcerated or it was deep in the skin even though it was thin, etc). Even then, it has not been clearly established that this procedure would have actually been able to save his life. You would have known that it had the potential to spread sooner, but it might not have helped. Whenever we make a diagnosis of cancer, we always try to soften the blow and look on the bright side. This is human nature. Especially when there is a thin melanoma, it is very reassuring to people that it is likely they will beat the odds. But there still are odds. Once you have a malignant tumor, there is always the chance that it could spread or has spread via cells that cannot be seen now but eventually will grow and will then be detected. See? My response was even longer than your question! May your grandsons bring you joy and give you some peace in your grief.

Amy Taub, M.D.
Lincolnshire, IL

Question:

There is an area on my back that at one time was a painless lump the size of a dime it is now red, swollen, and has caused tenderness around the area, I was told by one person that it was a white mole and someone else said it was a cyst that has become inflammed? What does it sound like to you?

Answer:

Dear Jay...being a Nurse, I can't diagnose but...working at the VA Hospital Surgical Clinic, I saw lots of cysts like you describe. What we usually saw were hair follicles that became infected, producing fluid that caused the swelling and redness. If it is a cyst, it may need to be removed. We frequently removed them in our minor surgery clinic...not a big deal...Sometimes they resolve on their own, but, I would recommend you have it checked out by your family physician and see what he says... Good Luck Julie Adinolfe RN AskANurse

Question:

I have a raised mole on my forhead above the bridge of my nose. (I have had it checked, it isn't dangerous), I would like to get it removed, but everyone says it will leave a scar. Would the scar be as noticable then a large brown bump on my forehead?

Answer 1:

It depends somewhat on how you heal. Chances are the scar will be less noticible than your mole. David M. Metzner, MD

Answer 2:

Dear Renee, The scar will be a fine white line and may fall within other lines in that area. It will, however, be a scar and not a "natural" lesion. It will be flat and can be hidden with makeup if so desired.

Question:

All my life i have had a large raised mole on my nose. It is about 6 millimetres all the way around and i hate it. It makes me feel unattractive and whats more i often worry that one day it may become cancerous. My mum says because i've had it all my life it'll probably be fine because its sort of like a birth mark, but that still doesn't solve that fact that i hate the way it looks. Whenever i meet someone new i can always tell that they are looking at it and it makes me feel selfconsious and embarrased. Because its so big would it be possible to have it removed? would i need plastic surgery? the thought of a big operation really scares me.

Answer:

Dear Sarah, You mother is right and there is only a slight chance of this becoming a cancer, however, appearance is very important and I understand how you would like it removed. The procedure would not be a big one but that area is particularly difficult to remove a largish lesion from without special techniques. I would suggest that you visit with a plastic surgeon in your area to discuss the options. Unfortunately, lasers, dry ice, etc. will not permanently remove a mole and so surgery is necessary.

Question:

I have moles on the face. Is it possible to have them removed and not have scars?

Answer:

Dear Kate, If they are true moles (intradermal nevi), the answer to your question is no. They have a root and unless this is removed, they will recur. If they are removed adequately by laser or surgery, a scar will result. I have found that, on the face, it is better to surgically remove the moles since the scars are better, finer, etc. when the procedure is performed surgically.

Question:

I was interested in getting several dome shaped moles on my face removed. They are benign, but affect my esteem. I don't want to go under the knife for scarring reasons. How succesfull is a laser treatment. What type of laser should I look for. Do you know of any Docs. in Northern New Jersey, NYC area that perform laser mole removal. Thank You...

Answer:

Laser mole removal is experimental and doesn't work particularly well. Often the moles reoccur. So, in this case, I can't recommend lasers. Usually in my office we do a technique called a "shave removal". This essentially planes the mole off the surface and although it does involve a scalpel, does not require stitches. 95% of the time, dome shaped moles don't return when removed this way and often heal up very nicely. Of course your dermatologist would need to tell you what technique would be best for each mole, as some just aren't quite right for shave removal. I would get a few opinions on how they would be removed and go with the doctor whose description of the procedure made you feel the most comfortable and who seemed to care about you and your result.

Amy Taub, M.D.
Lincolnshire, IL

Question:

Hi Doctor Taub, well I am back, we just got home from the hospital around 9pm, we were there all day and I just got Brian settled for the night. First we had the dye in the back thing, I forget what you called it, but it took over two hours and they found 2 suspicious spots in both armpits, then came surgery, 5 hours worth! remember I said the doctor was planning on cutting about 1 inch around where the mole was? well he had to cut 6" around it!!! its so big and I feel so sad and for the lymph nodes, he removed 2 suspcious ones under the right armpit and 4 under the left. I am not sure why so many or what the out come is but I am getting really worried now. The doc isn't saying a whole lot just that he needs to have the lymph nodes looked at under a microscope and wants to see us back thursday or friday in his office. He also said something about the reason he had to cut so much more on Brian's back then originally anticipated, was because there seemed to be more root or something of the melanoma. I am not sure what all these means but I get the feeling its not good. I cried and cried all day while my husband laid in surgery. You know what though? after all that and I got him home he managed to give me a big hug and smile and said he loved me so much. I don't know if any of this tells you anything, but it sure confuses the heck out of me. Ihope to hear back from you soon. I am going to go try to lay down now and get some rest. its after 11pm and Im tired. thankd you doc!!! God Bless amy

Answer:

I am so sorry that so far the outcome isn't what we were hoping for. Until you have the final pathology we don't really know. If the lymph nodes are positive for cancer, the treatment usually given is interferon, an injectable medicine (he will be given the medicine to inject superficially into the thigh). Once you have the results, however, I want you to call the National Institutes of Health. They have many ongoing studies on the treatment of melanoma. There is a Dr. Rosenberg who has been very involved in research on melanoma that has spread and who has had some really good results. You can call 800-411-1222 to find out if your husband is a candidate or email prpl@mail.cc.nih.gov. I would specifically ask for Dr. Rosenberg' s studies. They will tell you what is involved but the treatments are usually "free", that is the study grants pay for the medications and the evaluations. Of course, you have to travel there to get it, which isn't ideal (The NIH is in Bethesda, Maryland). For more information go to www.nih.gov and click on clinical trials and search on melanoma. There you will see the trials available to you. Also there is medline plus which gives you info on melanoma. Be strong. Be positive. It is going to be hard but he really needs you.

Amy Taub, M.D.
Lincolnshire, IL

Question:

What is the best way to remove small moles on my face? They are flat moles and I was wondering if a skin peel or laser would work?? Or is there another way?

Answer:

Dear Connie, It is hard to know without seeing them if they are true moles (which are usually raised) or some other kind of pigmented lesion. Usually, lasers which just remove pigment are very useful for these flat lesions and they can be removed without a scar or white spot. If they are true moles, they will recur with this type of treatment. The only good way of removing a true mole is by removing it along with its "roots". The problem is that this leaves a scar - usually a good one - but a scar nonetheless which is about 11/2 times as long as the mole was in diameter.

Question:

Dr. Amy, you have been so helpful to me thus far and I cannot tell you how much I appreciate all your help. I would love to share all this info with my husband but he doesn't want to talk about it at all, so this really helps me. I am being as strong as I can be for him and abiding by his wishes by not discussing it, the children on the other hand are worried, especially my youngest son who has Obsessive compulsive disorder, he is very worried and I keep reassuring him that daddy will be fine. you said that the .8 and level 4 don't go together, what exactly do you mean? and as far as the scale are there 2 different ones and why? according to the first scale you explained, brian (my husband) would be stage 2? but according to the second he is stage 1 right? Just making sure I am understanding. Yes the melanoma is on the upper center of his back, between his shoulder blades, if that helps at all. he has several more he needs to get removed in 2 months, and I am not sure what they would do if any of those showed up melanoma? could he have it in more then one mole? I guess what makes it all so difficult is we took care of his grandmother just last year who died in our home from lung cancer and it is still so clear in our heads how she suffered so badly especially the last week and I think we are all seeing that so fresh in our minds. this is when I try to be the strong one and reassure everyone that brian is young, healthy, and in an early stage, where grammy was 80, sick and at stage 3 when they found it. big difference. thanks so much for all your help but if you can explain about why the melanoma on his back is .8 and level 4 and why this doesnt fit? thanks and God Bless. amy

Answer:

The best thing you can do is to reassure everyone and leave your husband alone. This is the way he is dealing with it- you are dealing with it by trying to understand, but he wants to forget, so give him some space. I wouldn't involve your children much at all, only to tell them concrete things like Dad is having surgery but he'll be fine. Then be strong! He is not a stage 2. This is the only thing that matters ultimately, that the cancer hasn't spread. Breathe a huge sigh of relief when the lymph node is negative. Write me back when you have the surgical results. PS Glad I could help.

Amy Taub, M.D.
Lincolnshire, IL

Question:

My husband has had many atypical moles removed over the years, its been about 5 years since he has been seen by the doctor until last week. the doctor removed 3 more and called us 3 days later telling us one was malignent melanoma. He also has some on his scalp that he forgets to show the doctor, and he is supposed to have 4 more removed in december, my questions are 1.. how would we know what stage he is in, and 2. we go to the surgeon in two days, but what else will they do for him.and 3. two of our four children are very moley and one had a mole removed last year, how often should they be checked now? thanks!! amy

Answer:

First of all, you should go to a dermatologist who is thorough. You shouldn't have to ask to have his scalp looked at. His doctor should look everywhere- his scalp, between his toes and even at his scrotum. Second of all, your doctor should tell you what the depth of the melanoma is, called the Breslow depth. The dermatopathologist should measure the melanoma under the microscope. This is the most important piece of information you can get. This measurement is the most important predictor of future biological behavior of his tumor. You should ask your doctor if the mole was sent to a board certified dermatopathologist for this diagnosis. If not, seek out a second opinion. Finally, ask the surgeon whether they can do a sentinel lymph node biopsy. This involves injecting a dye at the site of the melanoma and then removing the first lymph node at the time the melanoma is re-excised. Again, if this node is negative, it is a very good sign that the melanoma has not spread. If this lymph node has melanoma, then you should consult an oncologist experienced in the treatment of melanoma. When you get all of this information back, write to me again. Your husband definitely should have surgery, which in many cases can be curative. You should take your children to a dermatologist experienced in this area for a total body examination. Although melanoma is rare in children, it does occur, and melanoma is partially an inherited disease. Finally, your husband should see an ophthalmologist for a complete eye exam as occasionally moles are present on the back of the eye. Good luck!!

Amy Taub, M.D.
Lincolnshire, IL

Question:

I have multiple types of scarring on my stomach and my back. I am curious as to know what kind of options are open to me for removing these scars? I know someone would need to evaluate me, however I am just concerned with knowing what types of proceedures are available for the followings scars? 1. Prednisone Stretch Marks? 2. Scars from removing active moles. 3. Moles.

Answer:

Dear Melissa, If the stretch marks are red and raised, a laser can be used to reduce the redness and flatten them. If they are white, there is very little that can be done at present. Some of the newer non-resurfacing, collagen stimulating lasers may prove useful for stretch marks but this is a yet a theory. The actual surgical scars from mole removal can be improved with laser resurfacing or sometimes the scar must be revised surgically.

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