Downtime after naevus removal:
wound stages by method, scar maturation and sun

What happens on the day of mole removal?

On the day, the site is numb from local anaesthetic and covered with a dressing, and what sits under the dressing depends on the method chosen after the dermatoscope examination. Every mole at Dr Sin Yong's practice is scoped before anything touches it, and the method follows the mole's type, depth and location, as the mole removal Singapore page explains; a mole with atypical features is excised for histology or referred, never ablated.

After CO2 laser removal of a flat mole the site is a small, shallow, raw dimple where the mole was vaporised in fine layers, with a pale or slightly charred base. After radiofrequency removal of a raised mole it is similar, because the energy shaves and seals in one motion, so there is little bleeding. After shave removal the site is a flat raw base at the level of the surrounding skin, like a small graze, which may ooze a little under the dressing. After surgical excision the site is a fine sutured line, longer than the mole was wide, because the wound is closed as an ellipse to lie flat.

As the anaesthetic wears off the site stings or throbs mildly, and paracetamol is usually enough. Keep the first dressing on and dry for the time you were told. Written aftercare is given on the day; the mole removal aftercare page sets out the wound care in full.

What do the following days look like, method by method?

Once the first dressing comes off, the wound is cleaned gently with water, patted dry, dressed with a thin layer of ointment and covered if it is somewhere that rubs. A wound kept moist heals with less crusting than one left to dry, and the crust that does form is left to separate on its own. The stages differ by method.

Healing is slower on the back, shoulders and legs than on the face, because the blood supply is poorer and the skin is under more tension, and a wound on the lower leg can take noticeably longer to close. Itching as the wound closes is ordinary and eased with the ointment rather than scratching.

“Scarless mole removal is a marketing phrase. What I can plan is the smallest, flattest mark for the method the mole needs, and what you can control is the sun on it afterwards.”

Dr Sin YongOn what is left after a mole is removed

How does the mark mature, and what are the sun rules?

Every removal leaves something, and the realistic objective is the smallest, flattest mark the method allows. The new skin is pink when the crust comes away, because it is thin and its vessels are close to the surface. Over the following months the pink fades, the collagen underneath remodels, a laser dimple fills in, and an excision line softens and flattens. The mark reaches its settled appearance slowly, which is why it is not judged early and why a mark that is still pink is not a mark that has failed.

Two things decide how it settles. The first is sun. New skin darkens readily if it is exposed, and in Asian and darker skin a healed site can turn into a brown mark, post-inflammatory hyperpigmentation, that lasts longer than the wound did; a paler patch can also occur, particularly after laser. Protect the healed site with a broad-spectrum sunscreen every day until it has settled, and with a hat or shade where it is on the face or neck. The post-inflammatory hyperpigmentation page explains how a dark mark is assessed. The second is scar tendency. A thick, raised, itchy scar forming at the site is a hypertrophic scar or keloid, more likely on the chest, shoulders, upper back and jawline and in anyone with a personal or family history of them; it is treated if it develops, and the keloids and hypertrophic scars page describes the difference.

What is not normal after mole removal, and when should you call?

Not normal: redness that spreads outwards from the site; warmth, swelling or pain that increases rather than settles; pus or a thick yellow crust; fever; bleeding that does not stop with pressure; a wound that opens after sutures are removed; a scar that thickens, rises or itches persistently; or a mole that grows back in the healed site. Each is photographed and sent rather than watched. Increasing redness, warmth and pus point to infection, which is treated promptly so that it does not widen the scar.

Regrowth deserves its own note. Pigment that reappears in a laser or shave site is usually residual naevus cells from the deeper part of the mole, and it is examined under the dermatoscope rather than simply treated again, because a lesion that recurs is re-assessed, and if tissue was not sent the first time it may be excised for histology the second. Any new change in a mole elsewhere, during or after recovery, is checked on the same visit. If tissue was sent for histology, the result is given when it returns; ask if you have not heard. Contact the clinic during clinic hours; the complication care page lists what goes to an emergency department the same day, wherever you are.

How should you plan mole removal around work, exercise and events?

Plan around the dressing and the crust. A site on the face heals in full view, so a facial mole is better removed when you can wear a small dressing and then a crust for a short period without a photograph or event in the way; make-up goes around the site, not over it, until the skin has closed. A site on the back or leg is easier to hide but slower to heal and more exposed to friction from straps, waistbands and exercise. Showers are fine once the first dressing has come off; swimming, baths and saunas wait until the skin has closed, and exercise that stretches or sweats into the site waits for the crust to separate or, after excision, for the sutures to come out.

Sun is the rule that outlasts the others, and a removal immediately before a beach holiday is the wrong order. Flying is usually fine with a dressing; the flying after treatment page covers what to carry and when to message. Whether your mole should be removed at all, by which method, and what mark to expect at its site is decided at consultation, after the dermatoscope examination.