Toronto Nevus (Mole, Birthmark) Removal
What is Nevus (Mole, Birthmark)?
A nevus is a dark spot on the body caused by clusters of overactive coloured skin cells. Sometimes there is also hair protruding from the nevus. It is more colloquially known as a mole or birthmark, and usually appears after birth anywhere on the body. Sometimes, these nevi may develop into skin cancer, so it is important to regularly monitor any changes to it. The risk of a nevus turning cancerous is related to its size, colour, location and shape. Your doctor would be best at determining if a nevus is vulnerable.
What are the signs and symptoms?
You can typically recognize a nevus from its much darker colour compared to the surrounding skin. Variations on nevi include the size, the presence or absence of hair, regular or uneven borders, or a texture that can feel either smooth or flaky. Make sure you and your family doctor regularly monitor your nevus, and report any changes to it such as bleeding, colour change, inflammation, itching, ulcerations, pain, or a change in size and texture.
These are both pictures of normal nevi
The ABCs for the signs and symptoms of skin cancer (melanoma)
If your skin lesion or mole exhibits any of the following traits, you should go and see your doctor who would be able to correctly assess whether it is malignant or be able to send you to a specialist who can.
Asymmetry – the skin lesion is not round and symmetrical
Border – the border of the lesion is uneven
Colour – the lesion has multiple colours including brown, black and/or tan
Diameter – the size of the mole is larger than 6mm
Enlarging – the lesion is rapidly growing in size
What kind of tests can I undergo?
As a precaution, you or your doctor might measure the mole and/or take pictures of it every year to check if it is increasing in size. A sudden size increase could indicate that the mole has turned into skin cancer, and it would need to be excised if it had. A skin biopsy, where a section of the mole is removed for testing, could also help to determine if there are any cancer cells present.
What are the treatment options?
Usually, no treatment is needed if the nevus is not changing and your family doctor does not consider it to be harmful. Careful monitoring and the use of strong sunscreen when outdoors are sufficient preventative measures. However, if your doctor thinks that it may pose a cancer risk, or if it is causing emotional issues because of its appearance, then surgery is an option. Lasers and dermabrasion are also alternative treatment options, but these may not remove the root of the mole and would also make it more difficult for a doctor to detect skin cancer. Multiple treatments of laser or dermabrasion may also be necessary to achieve the desired result.
What can I expect from surgery?
The surgical procedure to remove a smaller nevus is quite easy. The surgery itself would typically take approximately 15 minutes. Local freezing would be used, and about 20-30 minutes would be added to the surgery time to allow for the freezing to set in. However, because of the local freezing, the patient would be fit to drive home afterwards. Once the specimen has been excised, it will be sent to a lab to be tested for any malignancy. Stitches will be needed, and will typically be removed 5-14 days later, depending on the size and location of surgery. Redness is normal even after the stitches have been taken out, but after 4-6 months the scar should be hardly visible. There should be minimal to no pain after the local freezing has worn off, but Tylenol Extra Strength can be taken if there is.
What are the risks?
The risks of excising a nevus are very rare but can include infection, suture reactions, bleeding, bruising, and scarring. Please speak to your doctor about any medications you are taking and if you have had abnormal scarring (keloids or hypertrophic scars) in the past.
How much will it cost?
Unfortunately, the surgery to remove a benign nevus is not covered by OHIP. A consultation with Dr. Hong is recommended to find out the exact price for your procedure. Without a referral from your family doctor, an $80 consultation fee will be required, but it will be applied towards the cost of the surgery. There is no additional fee for follow up appointments such as the removal of sutures.