Mole Check Before Removal: What the Doctor Looks For
Medical Director Dr Sin Yong explains what happens at a mole check before removal, the warning signs, what a dermatoscope shows and when a mole goes to the laboratory instead of the laser.
WhatsApp to Enquire →Key facts ↓A mole check before removal decides whether a mole may be removed for appearance at all. The doctor takes a history, compares the mole with your others, looks for ABCDE and EFG warning signs and examines it with a dermatoscope. Clearly benign moles can then be shaved, lasered or excised; doubtful ones are excised for laboratory examination or referred.
On this page
- ABCDE: a review of melanoma diagnosis recommended expanding the ABCD signs to ABCDE, adding evolving, and keeping the diameter threshold at 6 mm [1].
- Dermoscopy: in a meta-analysis of nine clinical studies, dermoscopy was more accurate than the naked eye for melanoma, with a relative diagnostic odds ratio of 15.6 [3].
- Shaved moles can regrow: in 204 common moles removed by shave excision, pigment returned in 40 scars, about 1 in 5, at review [5].
- Regrowth can mimic melanoma: a benign mole regrowing after incomplete removal can show atypical cells that resemble melanoma under the microscope, a pattern called pseudomelanoma [6].
- Palms, soles and nails: in a US registry of 1,413 acral lentiginous melanomas, five-year melanoma-specific survival was 80.3 in 100, against 91.3 in 100 for cutaneous melanoma overall [7].
Why does a doctor examine a mole before removing it?
Because removal for appearance is only appropriate once a mole has been judged benign, and some removal methods leave nothing behind to examine.
Most moles are harmless, and most people who ask for mole removal want a raised mole on the face taken down for appearance. The check is there to find the few spots that are not ordinary moles: an early melanoma, another skin cancer, or a lesion that only looks like a mole. Those need a different plan, and finding them before treatment is far easier than after.
The method matters too. Laser vaporises the tissue it treats, so a lasered mole can never be examined under a microscope. A shave removes the raised part and leaves the deeper cells. Only excision sends the whole mole to the laboratory. That is why a mole is examined first, and why the method is chosen after the examination rather than before it.
What happens at a mole check before removal?
A mole check takes a history, looks at the mole and its neighbours, examines it under a dermatoscope, records photographs and ends with a plan: remove, watch, excise or refer.
- History. How long the mole has been there, whether it is new, whether it has changed in size, shape, colour or height, and whether it itches, bleeds or crusts. A personal or family history of melanoma, many moles, or past severe sunburn matters.
- Looking at the whole picture. The mole is compared with your other moles. One that looks different from the rest, the “ugly duckling”, gets a closer look even if it meets no other warning sign.
- ABCDE and EFG. The doctor checks Asymmetry, Border, Colour, Diameter and Evolution, and for raised spots whether they are Elevated, Firm and Growing.
- Dermoscopy. A dermatoscope magnifies the mole with polarised light and shows pigment network, dots, globules and vessels beneath the surface.
- Photographs. Clinical photographs, with and without the dermatoscope, are taken with your consent and kept in your record. They are the baseline for any later comparison.
- The decision. You are told what the mole is most likely to be and which of four paths fits: cosmetic removal, a review after an interval, excision with laboratory examination, or referral to a dermatologist.
At IN Eternity Clinic, Dr Sin Yong examines every mole with a dermatoscope before any removal is discussed. A mole with concerning features is not removed for appearance; you are referred for specialist assessment and excision with laboratory examination.
What are the ABCDE signs of a mole that needs checking?
ABCDE stands for Asymmetry, Border irregularity, Colour variation, Diameter over about 6 mm and Evolving. Of the five, change over time matters most.
| Sign | What it means | What is more reassuring |
|---|---|---|
| Asymmetry | One half does not match the other in shape or colour | A round or oval mole that mirrors itself |
| Border | Ragged, notched or blurred edge that fades into the skin | A smooth, even, well-defined edge |
| Colour | Several shades: brown, black, red, white or blue-grey in one spot | One even shade of brown |
| Diameter | Larger than about 6 mm, the size of a pencil eraser | Small and unchanged for years |
| Evolving | Any change in size, shape, colour, height, or new itching, tenderness or bleeding | No change in your photographs over months |
| EFG | A bump that is Elevated, Firm and Growing over weeks to months, even if pink or skin-coloured | A soft raised mole present since youth |
| Ugly duckling | A mole that looks unlike your other moles | Moles that resemble each other |
The original ABCD criteria were later expanded to ABCDE because change over time proved to be one of the most useful prompts, while the 6 mm threshold was kept [1]. Some melanomas do not follow ABCDE at all, particularly raised, pink, fast-growing ones, which is why EFG and the ugly duckling sign are used alongside it. A mole on the face that you simply want removed may meet none of these signs, and that is the usual result.
What does a dermatoscope show that the eye cannot?
A dermatoscope shows the pattern of pigment and blood vessels beneath the surface, which separates most benign moles from lesions that need a closer look.
A dermatoscope is a handheld magnifier with its own light, usually polarised, that cancels surface glare. Under it, an ordinary mole tends to show a regular network or evenly spaced dots and globules, while worrying features include an irregular or broken network, uneven dots, streaks at the edge, blue-white areas and unusual vessels. The criteria were standardised by international expert consensus [4], and in clinical practice dermoscopy improves the accuracy of melanoma diagnosis compared with the naked eye [3].
Dermoscopy also identifies the look-alikes that are not moles at all: seborrhoeic keratoses with their stuck-on, cerebriform surface, cherry angiomas with red lagoons, and dermatosis papulosa nigra in darker skin. These are treated differently from moles; see skin tag vs wart vs mole for the common confusions.
Dermoscopy is not a biopsy. It raises or lowers suspicion; it cannot prove that a lesion is benign. When suspicion remains, the next step is the laboratory, not the laser.
“A mole that is lasered cannot be examined afterwards. So the question is never just how to remove a mole, but whether this one should be removed for appearance at all.”
What can the result of a mole check be?
There are four usual outcomes: removal for appearance, a watch with photographs, excision for the laboratory, or referral to a dermatologist.
| What the check finds | What usually happens next | Why |
|---|---|---|
| Clearly benign raised mole, unchanged for years | Cosmetic removal can be discussed: shave or CO2 laser level with the skin, or excision | Low suspicion; the method is chosen for appearance and recurrence |
| Benign flat mole | Often left alone; excision if removal is wanted | Laser tends to leave deeper pigment that returns |
| Mildly uncertain, no high-risk features | Photographs, then re-examination after an interval to look for change | Change, or the lack of it, is informative |
| Doubtful features on dermoscopy | Excision so the whole mole is examined in the laboratory | Only histology can settle the question |
| Concerning features (ABCDE, EFG, ugly duckling) | Referral to a dermatologist for assessment and excision with laboratory examination | Not a cosmetic case; it is not removed for appearance |
| Not a mole (seborrhoeic keratosis, angioma, wart) | Treated as that lesion | Different lesions need different methods |
If cosmetic removal is appropriate, the methods, healing and scarring are covered in mole removal in Singapore. Excised moles are sent for histology, and the result is reviewed with you.
When is a biopsy needed before a mole is removed?
A biopsy is needed whenever a mole has features that dermoscopy cannot clear: change over time, irregular structure, a new mole in adulthood that looks atypical, or bleeding without injury.
For a mole that might be melanoma, the usual biopsy is excision of the whole lesion with a small margin, because the pathologist needs the full depth and edges to diagnose it and, if needed, to measure thickness. A partial sample can miss the most important part of an uneven lesion.
| Type of sample | What is taken | When it is used |
|---|---|---|
| Excision (excisional biopsy) | The whole mole with a narrow rim of skin, closed with stitches | Suspicious pigmented lesions; flat or deep moles; any doubt |
| Shave | The raised part of the mole, level with the skin | Clearly benign raised moles; the tissue can still go to the laboratory |
| Punch | A small cylinder of skin | Selected rashes or large lesions where a sample from one area is enough |
| Laser | Nothing; the tissue is vaporised | Only moles already judged benign |
Partial removal has another drawback. A benign mole that regrows after an incomplete shave can show atypical cells that look like melanoma under the microscope, called pseudomelanoma [6], so the original pathology, if there was any, is useful at a later check. After shave removal, pigment returned in about 1 in 5 scars in one series [5]; returning pigment is examined again rather than lasered.
Which moles need prompt medical attention?
See a doctor within days, not months, for a mole that is changing quickly, bleeding without injury, or a new dark streak on a palm, sole or nail.
- A mole that has grown or changed colour over weeks to months.
- A raised, firm, pink or skin-coloured bump that keeps growing (the EFG pattern).
- Bleeding, crusting, itching or a sore that does not heal within three to four weeks.
- A new or widening dark band in a nail, or a dark patch on the sole or palm. Acral melanoma is a larger share of melanoma in darker-skinned people and tends to be found later [7].
- A mole that looks different from all your others.
These are reasons for a medical assessment, usually by a dermatologist, not for cosmetic removal. In Singapore you can see a general practitioner or polyclinic doctor for referral, or a dermatologist directly.
What Dr Sin Yong looks for
- Whether the mole is new or long-standing, and any change you or your photographs have noticed.
- How the mole compares with your other moles, and whether it is the odd one out.
- The dermoscopic pattern: a regular network or globules, or irregular structure, streaks, blue-white areas or unusual vessels.
- Site: palms, soles, nails, scalp and mucosa are examined with particular care.
- Depth and type: raised, flat or deep, which decides whether shave, laser or excision is appropriate if removal is suitable.
- Your skin type and scarring history, because the method also has to suit how your skin heals.
General clinical observations used at consultation; they describe what is checked, not any individual result.
How can you check your own moles between visits?
Look at your skin monthly in good light, photograph moles you want to watch with a ruler beside them, and compare against the photographs rather than memory.
- Use a full-length and a hand mirror, or ask someone to look at your back and scalp.
- Include palms, soles, between the toes and the nails, which are often missed.
- Photograph a mole straight on, in daylight, with a ruler or coin for scale, and repeat every three months.
- Note any mole that is new after your thirties, changing, or unlike the rest, and bring the photographs to your check.
If you are planning removal of a mole on the face, the timing guide and look-alikes are in mole on face: when to get it checked.
Frequently asked questions
Do all moles need to be checked before removal?
Yes. Every mole should be examined, usually with a dermatoscope, before it is removed for appearance. Most are clearly benign and the check is quick, but it is the only way to find the few spots that should be sent to the laboratory or referred, and it decides which removal method suits the mole.
How long does a mole check take?
Checking one or two moles usually takes a few minutes within a consultation: history, comparison with your other moles, dermoscopy and photographs. A full-body skin check takes longer. If cosmetic removal is appropriate it can often be planned at the same visit.
Is a mole check painful?
No. A history, a look at your skin and dermoscopy are non-invasive; the dermatoscope simply rests on or near the skin. Discomfort only arises if a biopsy or removal is done, and that is preceded by a small injection of local anaesthetic.
Can a doctor tell if a mole is cancer just by looking?
Not with certainty. Looking, especially with a dermatoscope, raises or lowers suspicion and is more accurate than the naked eye, but only laboratory examination of the tissue gives a diagnosis. That is why doubtful moles are excised for histology rather than lasered.
Why not just laser a mole that looks harmless?
Laser is reasonable for a mole already judged benign, but it vaporises tissue, so nothing can be examined afterwards. If a lasered spot later regrows or changes, there is no pathology to compare with. A mole with any doubt is better excised so the whole of it reaches the laboratory.
What does a biopsy involve?
After a local anaesthetic injection, the whole mole is usually removed with a narrow rim of skin and closed with fine stitches, and the tissue goes to a pathology laboratory. Results usually take about a week or two, and the stitches are removed after one to two weeks depending on the site.
Should I get a mole checked if it has been there since childhood?
A mole that has looked the same for many years is usually benign, but it should still be examined before removal, and any change in an old mole is a reason to have it seen. Larger moles present since birth may need a dermatology opinion before any treatment.
Can a mole come back after removal?
Yes, particularly after a shave or laser, which leave deeper cells. In one series of shave excisions, pigment returned in about 1 in 5 scars. Regrowth is not usually dangerous, but it should be examined again, and the original pathology report, if there was one, helps.
Book an assessment
IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, Singapore 228210. By appointment with Medical Director Dr Sin Yong. Monday to Saturday, 11am to 8pm. WhatsApp or call +65 8815 3008. At IN Eternity Clinic a consultation fee applies, and it is waived if you go ahead with any medical treatment; the fee is S$120.
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References
- Abbasi NR, Shaw HM, Rigel DS, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004;292(22):2771-2776. doi:10.1001/jama.292.22.2771
- Tsao H, Olazagasti JM, Cordoro KM, et al. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol 2015;72(4):717-723. doi:10.1016/j.jaad.2015.01.025
- Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol 2008;159(3):669-676. doi:10.1111/j.1365-2133.2008.08713.x
- Argenziano G, Soyer HP, Chimenti S, et al. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol 2003;48(5):679-693. doi:10.1067/mjd.2003.281
- Ferrandiz L, Moreno-Ramirez D, Camacho FM. Shave excision of common acquired melanocytic nevi: cosmetic outcome, recurrences, and complications. Dermatol Surg 2005;31(9):1112-1115. doi:10.1097/00042728-200509000-00005
- Dymock RB, Menz J. Recurrent melanocytic naevi following partial removal (pseudomelanoma). Australas J Dermatol 1986;27(2):67-69. doi:10.1111/j.1440-0960.1986.tb00291.x
- Bradford PT, et al. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005. Arch Dermatol 2009;145(4):427-434. doi:10.1001/archdermatol.2008.609
These sources describe mechanisms and general evidence. They are not a promise of any individual result; suitability is decided at an in-person assessment.