Managing Deep Moles and Keloid Concerns in Cosmetic Surgery - Plastic Surgery

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Keloid after mole removal


Hello, Dr.
Chou.
Six years ago, I had a mole treated with laser at a dermatology clinic, but it seems that because the mole was deeper, it has grown back, even larger and darker, and it is slightly raised.
I am considering having it treated again, and after researching, it seems that many people recommend surgical excision.
However, I am very concerned about scarring, as I have a tendency to develop keloids.
The diameter of the mole is approximately 0.2 cm.
Could you please advise me on whether I should proceed with treatment? Thank you.

H, 10~19 year old female. Ask Date: 2022/06/11

Dr. Zhou Hongzhang reply Plastic Surgery


1.
Some moles are deeper and located in the dermis, making them more prone to recurrence after laser treatment.
2.
For large and deep moles, excision is often the only option, and similarly, it will leave a scar.
3.
If the scar is more aesthetically pleasing than the original mole, it may be easier to accept the scar.

Reply Date: 2022/06/11

More Info


When it comes to managing deep moles and keloid concerns, particularly in the context of cosmetic surgery, there are several important factors to consider. Based on your description, it seems that you have a mole that has returned after laser treatment and is now larger, darker, and slightly raised. Additionally, your concern about keloid formation is valid, especially since you have a history of keloid scarring, which can complicate surgical interventions.

First and foremost, it is essential to understand the nature of your mole. Deep moles, or nevi, can sometimes be resistant to treatments like laser therapy, especially if they are located deeper in the skin. Surgical excision is often recommended for moles that are raised or have changed in appearance, as this method allows for complete removal and can provide a definitive diagnosis through histopathological examination. However, the risk of scarring, particularly keloid formation, is a significant concern for individuals with a predisposition to keloids.

Keloids are raised scars that occur due to an overproduction of collagen during the healing process. They can develop after any type of skin injury, including surgical procedures. Given your history of keloid formation, it is crucial to discuss this with your surgeon. They may recommend a few strategies to minimize the risk of keloid formation, such as:
1. Preoperative Assessment: A thorough evaluation of your skin type and keloid history can help the surgeon plan the best approach. They may consider using techniques that minimize trauma to the surrounding skin.

2. Surgical Technique: The surgeon may opt for a technique that reduces tension on the wound edges, which can help decrease the likelihood of keloid formation. This might include using specific closure techniques or placing the incision in a less visible area.

3. Postoperative Care: After surgery, proper wound care is essential. Your surgeon may recommend silicone gel sheets or silicone ointments to apply to the wound once it has healed. These treatments can help flatten and soften scars.

4. Steroid Injections: If a keloid does form, steroid injections can be administered to help flatten the scar. This is often done in conjunction with other treatments.

5. Alternative Treatments: In some cases, dermatologists may suggest alternative treatments such as cryotherapy, laser therapy, or radiation therapy for keloids, depending on their size and location.

Regarding your specific mole, if it is indeed causing you concern and has changed in size or appearance, it would be advisable to have it evaluated by a dermatologist or a plastic surgeon who specializes in cosmetic procedures. They can provide a comprehensive assessment and discuss the potential risks and benefits of surgical excision versus other treatment options.

In conclusion, while surgical excision may be the most effective way to manage your mole, the risk of keloid formation is a legitimate concern that should be addressed with your healthcare provider. Open communication about your fears and previous experiences will help your surgeon tailor a treatment plan that minimizes risks and addresses your cosmetic concerns. Always ensure that you are comfortable with the proposed plan and that you understand the potential outcomes, including the possibility of scarring.

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