Direct Mole Excision For relatively small moles with a diameter of 25px or less, they can be treated by mole excision and direct suturing, while for some parts with relatively loose skin, larger moles can be excised. For plastic surgeons, this surgery may seem small, but in fact, it has high requirements for surgeons’ basic theory, basic surgical skills and aesthetic qualities. Here we use several examples to talk about direct nevus excision surgery. 1.Direct excision of lower lip nevus This is a case of a patient with a lower lip nevus, the maximum diameter of the nevus is about 7mm. A characteristic of facial nevus excision is that the surgeon cannot excise the nevus exactly according to the form of the nevus for the convenience of surgery, for example, for a round nevus, the round excision method cannot be used, but the pike excision method should be used to excise the nevus, as long as this As long as this excision method is used, after the wound is closed, the skin will not be piled up on both sides of the wound due to the presence of excess skin, forming an unsightly bulge, which is generally called “cat’s ear” deformity. After removal of the nevus, the incision should be closed with a good tension-reducing suture using a layered suture method to ensure the surgical result (Figure 1). Figure 1. (Left) Lower lip nevus with a maximum nevus diameter of about 7 mm. (Middle) Shuttle-shaped surgical incision design. (Right) Post-surgical image 2. Direct excision of nevus on the back This is a case of congenital nevus of black pigment on the back, characterized by irregular shape of the nevus, located on the back, and the widest part of the nevus can reach 100px. However, because the normal skin around the nevus is relatively loose, the treatment can be performed by direct excision of the nevus (Figure 2). Figure 2. (Left) Showing a nevus on the back. (Right) Post-surgical image 3. direct excision of plantar nevus This is a patient with a plantar nevus. For such a nevus, we recommend prophylactic nevus excision due to frequent friction during walking (Figure 3). Figure 3. (Left) Showing plantar nevus and surgical incision design. (right) Post-surgical image Fractional nevus excision surgery Fractional excision is the removal of a nevus multiple times, narrowing the nevus with each excision, thus eventually removing the nevus completely and avoiding more complicated treatments such as skin grafting and flap transfer; fractional excision uses the inherent viscoelasticity of the skin itself to stretch the skin over time; this technique ensures immediate closure of the wound and creates a shorter incisional scar, and also reorientation of the scar, which is closer to the skin relaxation line, resulting in a better treatment effect; fractionated excision is suitable for small to medium sized nevi. Note: After each partial excision of a nevus lesion, the lesion will rebound and widen to a certain extent due to tension and other reasons; secondly, in some parts that are very sensitive to the pulling force, such as the lower lid and the corners of the mouth, if the nevus is large in area, using the method of fractionated excision may lead to the displacement and deformation of the above-mentioned structure, at this time, skin expansion technique should be considered for treatment. Finally, for moles with larger areas, it is also inappropriate to treat them with the method of split excision. This is a case of a facial nevus with a size of about 4 × 50 px. Since the long axis of the nevus is roughly parallel to the direction of the orofacial fissure, it will not cause displacement of the orofacial angle after fractional excision, so treatment was performed by fractional excision, with about 2/3 of the lesion removed in the first operation, and after 6 months, a second excision was performed to remove the nevus completely (Figure 4). Figure 4. (Right) A facial nevus measuring about 4×50 px. (Middle) About 2/3 of the lesion area was removed in the first operation and sutured directly. (Left) After 6 months, the remaining nevus was excised and the wound was closed with direct sutures, and there was no displacement of the corners of the mouth.