Mole Removal: Which Moles Can Be Removed, and Which Method Should Be Chosen?

Most moles do not require medical removal. They may be removed for diagnostic reasons, repetitive trauma, or cosmetic reasons. Before choosing a method, the most important question is whether the lesion is truly benign and whether histopathological examination is necessary.

Melanoma or other suspicious, changeable, atypical, or undiagnosed pigmented lesions should not be destroyed by destructive methods. In such cases, an appropriate biopsy/excision that allows for histopathological evaluation is preferred.

Intradermal nevi are often skin-colored or light brown, raised, dome-shaped benign nevi and may be removed for cosmetic reasons, especially on the face. Elliptical excision provides complete removal and is robust in terms of histopathology; however, it may leave a linear scar longer than the lesion.

In a randomized study, shave excision in nonpigmented intradermal nevi resulted in smaller scars and higher patient satisfaction compared to elliptical excision; however, recurrence and positive margins were higher. A 2026 systematic review/meta-analysis also showed that surgical excision provided the highest clearance and lowest recurrence, while lasers had higher recurrence rates with higher cosmetic satisfaction.

Destructive ablation methods can be used in some raised/intradermal nevi that are reliably assessed as benign clinically and dermoscopically. However, high-quality data directly comparing these methods with surgical or shave excision in melanocytic nevi are limited. The need for histopathology, lesion depth, and risk of recurrence are priorities in method selection.

In destructive ablation methods, the absence of linear incision and suture lines may be cosmetically appealing to some patients; however, there are limitations such as the inability to obtain histopathological samples, residual/recurrence, and post-inflammatory pigmentation.

Current small studies have reported positive cosmetic results with atmospheric plasma in benign facial lesions; however, these findings do not demonstrate a proven superiority over excision methods in melanocytic nevi.