Moles in Children: Surgical vs. Laser Removal Options

A 12-year-old girl has moles on the tips of her fingers and nails, as well as on the soles of her feet?

Hello, doctor.
My daughter is 12 years old and has a mole on the sole of her foot and another on the tip of her finger.
After visiting a dermatologist, we found a black line on her fingernail, which the doctor said is also a mole.
It currently appears to be benign, but the doctor still recommends removal.
There are options for surgical excision and laser treatment.
The doctor mentioned that it will need to be done eventually, and it's better to do it sooner rather than later, as it may be too late if it turns malignant! I would like to know: 1.
Which is better, surgical excision or laser treatment? 2.
Should a biopsy be done beforehand to check for benign or malignant characteristics, or should we proceed directly with excision? 3.
Do all moles on the body need to be removed? 4.
How should moles located on the nail be excised? Is it necessary to remove the nail? 5.
If it is malignant, what kind of follow-up treatment will be required? Will it affect the child's development? Thank you.

jessie, 10~19 year old female. Ask Date: 2014/12/03

Dr. Wu Yuxin reply Dermatology

1.
Surgical excision provides a higher clearance rate, while laser treatment is more likely to leave residual tissue and result in recurrence.
2.
If the lesion is small, it can be excised directly.
3.
There is no need; each lesion should be evaluated individually.
4.
Yes, nail removal is necessary.
5.
The malignancy depends on the degree, presence of metastasis, and cellular morphology, among other factors.
It cannot be easily explained in a few words, so it is advisable not to be overly anxious.
If you are concerned, it is best to seek medical consultation first.

Reply Date: 2014/12/03

More Info

When it comes to managing moles in children, particularly those that may have the potential to become malignant, it is essential to consider various factors, including the type of removal method, the necessity of biopsy, and the implications of treatment on the child's health and development. Here’s a comprehensive overview addressing your questions:
1. Surgical Excision vs. Laser Removal:
Surgical excision is generally considered the gold standard for mole removal, especially if there is any concern about malignancy. This method allows for complete removal of the mole along with a margin of surrounding tissue, which can be crucial for accurate diagnosis and treatment. Laser removal, while effective for cosmetic purposes and benign lesions, may not provide the same level of tissue sampling and may leave behind some residual cells, which could complicate future assessments if the mole is found to be malignant. Therefore, if there is any suspicion of malignancy, surgical excision is typically recommended.

2. Pre-operative Biopsy:
In many cases, if a mole is suspected to be malignant or atypical, a biopsy may be performed prior to complete excision. This involves taking a small sample of the mole for histological examination to determine whether it is benign or malignant. However, if the mole is large or if there is a significant concern for malignancy, the physician may recommend proceeding directly to excision to ensure complete removal and to avoid delays in treatment.

3. Removal of All Moles:
Not all moles need to be removed. The decision to excise a mole should be based on its characteristics (such as size, color, asymmetry, and changes over time) and any symptoms it may cause. Regular monitoring of moles is essential, and any changes should prompt a consultation with a dermatologist. Moles that are asymptomatic and have not changed over time may not require removal.

4. Moles on the Nail Bed:
Moles located on the nail bed can be particularly challenging. If a mole is present under the nail, it may require a more complex surgical approach. In some cases, the nail may need to be temporarily removed to allow for proper access to the mole for excision. This decision would be made by the surgeon based on the mole's characteristics and the potential for malignancy.

5. Post-operative Treatment for Malignant Moles:
If a mole is found to be malignant after excision, further treatment may be necessary. This could include additional surgery to ensure clear margins, as well as possible treatments such as chemotherapy or radiation, depending on the type and stage of the cancer. The impact on a child's development will depend on the treatment required and the child’s overall health. Pediatric oncologists and dermatologists will work together to create a treatment plan that minimizes any potential impact on the child's growth and development.

In conclusion, it is crucial to follow the recommendations of your dermatologist and consider the potential risks and benefits of each removal method. Regular monitoring of moles and prompt evaluation of any changes are key to ensuring your child's health and safety. If there are any concerns about the moles, it is advisable to seek a second opinion or further evaluation from a pediatric dermatologist.

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