Dr Rakesh Patalay is a Consultant Dermatologist and Dermatological Surgeon who works privately at Dr Sam
Bunting + Associates in London. He trained at University College London and holds a PhD in dermatology, with
sub-specialist expertise in skin surgery, the early diagnosis of skin cancers, and laser treatment. He is on the GMC
Specialist Register (GMC 4626136).
Maybe a mole was flagged at a check-up and you're now waiting to have it removed. Maybe you've simply had a mole for years that catches on your razor or your clothing, and you'd like it gone. Either way, once removal is on the table, the questions are usually the same: what actually happens, will it scar, and how long it takes to find out what the lesion is.
Why Might A Mole Or Skin Lesion Need Removing?
There are two quite different reasons a mole ends up being removed, and it's worth being clear about which applies to you.
The medical reason is that a lesion has features on examination or dermoscopy that need histological confirmation, or that you have a personal or family history that makes a cautious approach sensible. If you have had a professional assessment recently, the guide to what happens during a mole check covers how that decision gets made.
The cosmetic reason is simply that a mole is unwanted: it catches on clothing or a razor, sits somewhere visually prominent, or you'd just prefer it gone. This is entirely legitimate and does not require any medical justification. A mole is nevertheless always examined properly with dermoscopy before it is removed for cosmetic reasons, partly for reassurance and partly because it occasionally changes the plan.
What's The Difference Between A Biopsy And An Excision?
A biopsy's primary purpose is diagnosis: removing tissue, whether a thin surface shave, a small punch, or the whole lesion, so it can be examined under a microscope. An excision's primary purpose is removal. In practice, these overlap considerably: an excision does both jobs in a single procedure, which is exactly why it is the preferred approach whenever melanoma is a realistic possibility. A partial sample can under-represent the most concerning part of a lesion, and a shave that cuts across the base of a pigmented lesion can make it impossible to measure the full depth of the tumour, which matters for both diagnosis and staging.
What Happens During The Procedure?
The area is cleaned and injected with local anaesthetic, which causes a brief sting followed by numbness that lasts through the procedure. The planned procedure e.g. shave biopsy or excision will then determine how much tissue will be removed. Where melanoma is a possibility, UK guidance is complete excision with a deliberately narrow clinical margin of around two millimetres. For moles removed for a cosmetic purpose, as shave biopsy is often best.
The wound is then covered with a simple dressing.
What Happens To The Tissue Afterwards?
Every piece of tissue removed is sent to a specialist histopathology laboratory, where it is examined under a microscope by a dermatopathologist. The report confirms the diagnosis and, for any lesion of concern, whether it has been completely removed and how clear the margins are. Results are typically available within one to two weeks.
What Does Recovery And Scarring Look Like?
The scar depends on the type of surgery and the body site. Every excision leaves a scar; there is no way around that, but the aim is always a fine, well-healed line rather than anything prominent. Keeping the healing scar out of strong sun for several months helps prevent it darkening, and some areas, particularly the chest, shoulders and upper back, are more prone to a raised, thickened or keloid scar, which can usually be managed well if it happens.
A shave biopsy leaves a blemish the size of the footprint of the lesion being removed. This can be very subtle in some cases once it has healed, but there is always some mark present.
What If The Result Comes Back As Skin Cancer?
Our dermatologists will explain the diagnosis to you and guide you through the next steps.
Biopsy And Excision Methods At A Glance
| Method | What it involves | When it's used |
|---|---|---|
| Shave biopsy | A thin surface slice is removed with a blade, no stitches needed | Superficial, low-suspicion lesions, or cosmetic removal of a raised mole. Not appropriate where melanoma is suspected |
| Punch biopsy | A small circular tool removes a full-thickness core of tissue, usually closed with a single stitch | Sampling a rash or lesion where a small, deeper sample aids diagnosis |
| Excisional biopsy | The whole lesion is removed with a narrow margin of about 2 mm, closed with stitches | Preferred whenever melanoma is a realistic possibility |
| Wide local excision | A second, larger excision with a wider margin around the original site | After a confirmed skin cancer diagnosis; for melanoma the margin is guided by Breslow thickness |
Signs You Should Book An Assessment Rather Than Wait
- A mole or lesion was flagged as worth a closer look at a recent skin check.
- A mole changes in size, shape or colour.
- A mole has started bleeding, crusting, or itching persistently.
- A mole regularly catches on clothing, jewellery, or a razor.
- You'd like a long-standing, benign-looking mole removed for cosmetic reasons and want to understand the process first.
- You've had melanoma before and have a new lesion you're unsure about.
Frequently Asked Questions
Will removing a mole leave a noticeable scar?
Every excision leaves some scar, but the goal is a fine line that fades well over time, positioned along the skin's natural tension lines wherever possible. Scars continue to remodel and settle for twelve to eighteen months, so the early appearance is not the final one. Site matters too: areas like the chest, shoulders and upper back are more prone to a thicker scar than the face, and this is discussed before any procedure with a cosmetic element. Shave biopsy scars will still scar but they will be typically less noticeable than an excision scar.
How long does it take to get biopsy results back?
Typically one to two weeks, depending on the laboratory and whether additional specialist staining or a second opinion is needed for a complex case.
Can I have a mole removed just because I don't like the look of it, not because it's suspicious?
Yes, entirely. Cosmetic removal of a benign-looking mole is a legitimate reason to have a procedure, and no medical justification is required. The mole will still be examined properly with dermoscopy beforehand, partly for reassurance and partly because it occasionally reveals something worth discussing first, but wanting a mole gone for how it looks or how it catches on things is a perfectly good reason on its own.
What Happens If The Mole Comes Back As Cancerous?
If histology confirms a skin cancer, including melanoma, the next step depends on the specific diagnosis. Our doctors will guide you.
When To See A Consultant Dermatologist
Whether you're removing a mole for medical reasons or simply because you'd like it gone, it's worth having that removal carried out by a consultant dermatologist, with a proper assessment beforehand rather than a same-day, no-questions-asked approach. If the mole in question has not yet been properly assessed, the guide to what happens during a professional mole check is a good place to start. Dr Sam Bunting + Associates carries out mole checks. To book an assessment, contact the clinic at info@drsambunting.com or visit the Book an Appointment page.
