Question 1: What exactly is a black mole? Can they become malignant?
A: The scientific name of nevus is melanocytic nevus, which is a benign neoplasm formed by the local aggregation of melanocytes, almost everyone has it at all ages, and those who have it at birth are congenital pigment cell nevus. Some of them are hairy (hairy nevus is not equal to malignant) and may protrude from the skin, and the color may be tan, blue-black, black, or close to normal skin color. Generally, there are three kinds of nevi: junctional nevus, intradermal nevus and mixed nevus. Luo Xusong, Department of Plastic Surgery, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine
Performance of benign nevus: stable size and color, consistent color, neat edge and smooth surface.
The possibility of malignant change in benign small nevi is extremely small (about 1%), so we do not need to worry too much.
However, a significant portion of malignant melanoma does originate from nevi. Risk factors include: relatively large mole area (giant nevus), trauma and irritation, excessive sun exposure, and increasing age (malignant changes mainly occur in adults and elderly people over 30 years old, with few young onset and rare in children).
When a mole becomes malignant, there is often mild local tingling, burning, satellite lesions at the edges, sudden increase in size, deepening of color, redness and inflammation, rupture and bleeding, which requires vigilance. If malignancy may occur or is confirmed by biopsy, the lesion should be surgically removed as soon as possible.
The final diagnosis needs to be confirmed by removing the lesion and sending it for pathological examination, which needs to be differentiated from chromatophores, seborrheic keratosis, basal cell carcinoma, fibroma, etc.
Question 2: Is it better to laser or surgically remove a mole?
A: The two treatment methods, laser and surgery, are for moles of different sizes and depths and are not substitutes for each other.
Smaller and shallower moles (below 3mm and above the superficial dermis) can be treated with laser because the trauma formed after laser cauterization is smaller and shallower and the skin can heal by itself. The advantage is that the treatment does not need to extend to normal tissue, no sutures are required, and recovery is often faster than surgery. Laser treatment should be thorough, otherwise residual mole cells are prone to recurrence, and repeated laser treatments of more than 3-4 times on the same area are not recommended.
Larger and deeper moles (more than 3mm, below the deep dermis) need to be surgically removed, at this time, if laser treatment is performed, the trauma formed is large and deep, and the skin cannot heal by itself, and finally it is the formation of a lamellar scar (similar to a burn with a larger and deeper area). Moreover, the diagnosis of larger nevi is often more complicated and needs to be differentiated from some other lesions, so if laser treatment is done, it is impossible to do pathological examination, which can neither confirm the diagnosis nor know whether the burn is clean, and has no guiding meaning for future prevention and observation.
If the area of the mole is relatively large, but the color is light, the location is special, and the patient is very afraid of surgery, laser treatment can be tried once or twice, and if it is not effective, it should not be repeatedly stimulated.
Question 3: Will a mole leave a scar after removal? Can it be done without leaving a scar?
A: Doctors have only one answer: the surgery will definitely leave a scar. International studies have found that the only ones that do not scar are lower animals (such as geckos) and fetuses developing in the womb.
However, patients and doctors are not talking about the same thing when they talk about scarring.
When patients talk about keloid scars, they often refer to the kind of scar that is red, wide, clearly protruding, or even with obvious needle marks or centipede feet, like the one on the left in the picture below, which is the result of rough suturing after trauma.
The scar after the plastic surgeon’s fine suturing is more of a “mark” like the right picture below.
The formation of a scar between the incision sections is necessary for the surgical incision to heal, and this scar, which is internal and invisible to us, is like glue welding the incision together.
The scar that “spills out” from the surface of the incision is visible from the outside and is an eyesore, too much of it is called “hyperplastic scar”, which neither the patient nor the surgeon likes to see and will try to make it as minimal as possible.
How can this scarring be prevented? There is a long-standing misconception, induced by businesses, that all you need to do to prevent scarring is to apply some imported/expensive/biased scar medication and everything will be fine.
Scar prevention requires comprehensive treatment and joint efforts of doctors and patients.
Careful incision design, delicate surgery and suturing by the surgeon.
Patients should carefully reduce tension on the incision in the early post-operative period (especially in the first 1-3 months) so that the incision heals as finely as possible; (see my other article for details: No scarring after surgery? Reduce the tension of the incision is critical! Specific operation method (Figure))
During the 3-6 months period if the incision has increased, you can use some topical scar creams, not the more expensive the better.
Most patients end up in this stage of treatment.
A small number of patients still need further treatment such as scar injection and laser if there is still redness, hyperplasia and mild depression of the incision after six months of surgery, and most of these patients can still achieve more satisfactory results.
Therefore, the time cycle of scar prevention is relatively long, requiring investment of time and energy, patience, and no laziness, nor can it be achieved overnight.
Patients often ask: I am a keloid, am I suitable for surgery? In fact, as explained earlier, previous injuries and surgical scars do not mean you are a keloid. As shown in the picture below on the left, the hyperplastic scar left after abdominal surgery (some people have more, some have less) is a normal phenomenon and most people are not keloid.
Most people are not keloid. A true keloid is characterized by a scar that is much larger than the original injured area and grows like a tumor. This is called keloid!
Question 4: Can moles recur after removal? Will the surgery stimulate the nevus to become malignant?
A: Recurrence is very rare. Since the surgery is performed under direct vision to remove all the visible tissues (according to the principle of tumor removal, the normal tissues next to the tumor should be removed), and there are pathological examinations under the microscope after the surgery to see if the edges are cut cleanly, recurrence after surgery is very rare. Even if there is a recurrence, do not be nervous, it is only a small part of the residual nevus cells that have not been cut, and the nature of the nevus does not change, so it can be completely removed again.
Surgical excision is the most complete way to remove the diseased tissue, and after excision, only normal skin and some scar tissue are left in the area where the nevus was originally located, and there is no more nevus tissue to stimulate its malignant change.
Question 5: How long will the incision be after excision?
A: This is a question often asked by patients, in fact, it is also a geometric problem, as shown in the figure, let’s review our homework in secondary school together 🙂
The diameter of the mole is set to D
a. When the circle is brought together into a straight line, the length of the line is half the circumference of the circle (can you imagine it?). You can take a rubber band to compare), that is, the circumference multiplied by the diameter divided by 2, is 1.6D, and the cut is 1.6 times the diameter
b. If the nevus is a benign tumor, according to the principle of benign tumor excision, the incision should be on the normal skin 1 to 2mm outside the edge of the nevus (directly cutting along the edge of the nevus is easy to cut cleanly and will require another operation), then the incision increases to 1.6D+2mm. If the nevus is suspected to have malignant changes, this distance should be increased.
c. If you cut in a round shape, the result of direct suturing of the round wound is that the skin at both ends will buckle up (commonly known as cat ears), if you have a piece of cloth at hand you can try it. In order to avoid the formation of cat ears, the incision will be sewn flat, and both sides of the incision will be extended again to form a pointed pike, with the extension amount set to E
Combining the above three factors, the
The actual length of the final cut is 1.6D + 2~3mm + 2E
Give two examples of actual calculations
Example 1: A 5mm diameter mole, E is 2mm, the actual length of the incision is 1.6 X 5mm + 2mm + 2 X 2mm = 14mm, which is about 3 times the original diameter, isn’t it amazing?
Example 2: A 50px diameter mole with an E of 5mm, the actual length of the final incision is 1.6 X 20mm + 3mm + 5mm X 2 = 45mm, which is about twice the original diameter.
These two practical examples illustrate why the smaller the mole, the longer the incision appears to be after removal.
In reality, due to the difference in elasticity of different parts of the skin, the peculiarities of the local structure, the complexity of the mole shape, etc., the final incision length will only be longer than the calculated one!
However, plastic surgeons certainly do not want to have long incisions, it is almost a professional instinct (most of the various small incisions and minimally invasive cosmetic surgeries that have emerged over the years are the invention of plastic surgeons), and the longer incisions also require more effort for the surgeon to suture, increasing the workload. Therefore, the doctor will definitely try to make the incision as short as possible under the premise that the tumor is removed cleanly and the alignment is smooth.
Besides, the final result of the incision depends on the recovery situation, not the length of the incision. If the incision is long, it will not be obvious if the recovery is good; if the incision is short, it will not be ideal if the recovery is not good and a visible scar is formed.
Sometimes people also like to ask how many stitches will be sewn, which is often the language in literature. Doctors are least concerned about this issue, the key is to sew well, and the outside stitches will eventually be removed anyway.
Question 6: Will moles sink after excision?
A: A local defect will be formed after the removal of a mole, but the doctor will pull the two sides together and close them, so there will be no depression after the removal and suturing of a normal size mole.
Question 7: General anesthesia or local anesthesia? Is general anesthesia dangerous and will it affect intelligence? Do I need to be hospitalized?
A: The choice of anesthesia depends on the age and the size of the mole.
Young children younger than 7-8 years old need general anesthesia because they will cry and not cooperate during the surgery, making it difficult to complete the more delicate procedures required. General anesthesia is also required for larger procedures, such as those requiring skin grafts and dilators. General anesthesia requires hospitalization, while local anesthesia is mainly performed on an outpatient basis and does not require hospitalization.
General anesthesia here means anesthesia with tracheal intubation. It is not recommended to do intravenous anesthesia that does not control the airway, but only intravenous administration of drugs, which is very dangerous if the airway is obstructed during the operation.
Does general anesthesia affect brain function (including intelligence)? It depends on the duration and frequency of the drug, because general anesthesia drugs are eventually metabolized and excreted from the body, just like drinking and getting drunk (alcohol was also used for anesthesia in the past), the effect of a short drunken period on the brain is minimal, but if drunken frequently, it will definitely bring side effects.
Question 8: What is the right age for children to have surgery?
A: The physical development of the child and the mental development of the child should be taken into consideration.
Nowadays, with the advent and development of fetal surgery, there is in fact no limit to the age of surgery, but why is the age of the child still an important consideration in the final decision? This is because a general anesthesia surgery is a test of all human functions (especially heart, lungs, liver and kidneys), like a middle distance run, and all pediatric organs are still immature and relatively fragile, with insufficient response to various stresses and increased surgical risks. In addition, postoperative observation, care and cooperation with adjuvant therapy are more difficult for pediatric patients.
Therefore, if the nevus does not grow rapidly, the general anesthesia surgery can be placed after 2-3 years of age.
Question 9: What are the surgical methods? How to choose?
There are three general surgical methods as follows
1.Direct excision and suturing (there are also split excision and expansion before excision)
2, direct suture is difficult, or will cause deformity of the five senses, then perform flap transfer
3, the trauma is too large, the flap can not be used, then choose to implant
The principle of choosing surgical methods is: not to take complicated methods if simple methods can be used to solve the problem, and the order of choosing is 1→2→3, sometimes a combination of 2-3 methods.
Question 10: What psychological preparation should be done before the treatment?
A: It is also important to understand the disease objectively and correctly, and to build up a good psychology. A healthy mind is certainly conducive to a smooth recovery, and to look at the possible problems in treatment and the results of treatment in a rational way.
The following types of patients need to adjust their mindset first, otherwise they will not be suitable for treatment.
Sighing type.
They think that they are unlucky and God has given me a black mole, while others are shiny and bright.
When God closes a door for you, he will open a window for you at the same time, and you must have the advantages that others do not have.
Suspicious type.
Thinking that only you care about your own condition and that doctors are looking for something else.
In fact, on the road of fighting diseases, doctors and patients are absolutely of the same mind, both of them hope that the treatment effect is good, the cost and risk is low, that is, the gain is more than the loss, and the problem that patients think is also the problem that doctors think.
The only difference is that the patient will have a more emotional response, while the doctor has the expertise, he is performing these treatments every day, is familiar with the situations, and he needs to build a professional reputation through successful treatments. The doctor also has to conduct scientific research on difficult problems that are currently unsolvable and explore issues that are closely related to the disease.
Risk-averse.
Requires 0 risk and 100% guaranteed return.
Disease treatment, like all other human behavior, has some kind of uncertainty and risk, and can only do their best to avoid risk, but require 0 risk ……, only no treatment is no risk of treatment.
Perfectionist type.
They can’t understand the time required for treatment and recovery, and the discomfort they will experience during the process. They demand that the surgery results can withstand examination under all kinds of light (from dark light to sunlight), 360 degrees, and like to compare with some so-called “successful cases”.
Surgery is not PS after all, some kind of discomfort is unavoidable, after removing a mole, the recovery result can only be compared with the original mole, not with normal skin. You have to compare yourself with your past, not with others horizontally.
Self-talk type.
You have already heard some information from others or on the Internet, and you have some stubborn ideas. They come to the doctor just to get a final confirmation from the doctor, do not listen to different opinions from the doctor, and refuse to cooperate seriously with the doctor’s instructions after the operation.
Before visiting a doctor, you should also be like going to a monastery for meditation, first vacate yourself, let go of your existing ideas, and pay attention to the doctor’s analysis of the condition and explanation of the treatment plan, the doctor will tend to different treatment plans due to differences in experience and technology, if you feel confused after listening, you may want to see more doctors, listen to both, and generally form a preliminary overview of the treatment plan, and then combine your actual situation and tendency to make a choice.
When people have moles, they are either worried about the changes or the impact on their appearance, which is like a fish drinking water, and they know what they are doing. If it is their own child, parents really want to grow on their own body and suffer on behalf of their children. But a treatment, a surgery, is also a special journey in life, which will increase our experience, grow our courage, and give us the opportunity to understand ourselves from a unique perspective. I wish you all the best, and I wish you all the best in meeting your better self!