avogadro's number (except not)

August 24, 2007 10:20 PM

I have a doctor's appointment to get a mole looked at. What can I expect?

It is a raised mole on my face. It is smaller than a pencil eraser. I was told recently that it looks a bit bigger than it had in the past, also it has been itching periodically. I also have another mole, very similar in appearance but (to my best recollection) that has not had any weird symptoms; however, sometime within the last year (I may have had a sunburn) a top layer of one of the moles came off but I don't remember which one.

What is the doctor going to do? Just look at it or take a biopsy? (The mole is small enough and prominent enough on my face that taking a biopsy might be taking the entire mole and make me look slightly different.) Is my other mole going to be an issue? What are best best case and worst case scenarios?

How much should I be worrying?

posted by anonymous to health & fitness (19 comments total)

I have had mole examinations in the past. I had one mole that looked suspicious to the dermatologist on my shoulder. She took a biopsy, which involved numbing the area and then taking a dermal punch to remove a piece of it.

However, it was a flat-ish mole, and I think if it is a raised mole they may remove it entirely to biopsy it, if the dermatologist thinks it is suspicious. In any case, they will ask your permission first, and they will numb you first. My friend had a raised mole removed from her face, and she said it took less than a minute and she didn't feel it at all.

If the dermatologist does want to take the entire mole, it isn't a major procedure and you will be fine. Looking slightly different is certainly much better than letting a potentially malignant mole get out of control.
posted by bedhead at 10:42 PM on August 24, 2007

You are doing the right thing to go to your doctor. I assume it is a dermatologist you have trust in or whom was reccomended by someone you trust. Therefore, instead of worrying about it, just go to your appointment, see what he reccomends (he/she will either tell you to not worry about it, watch it further or to remove/biopsy it) and follow his reccomendation. "worrying is like saying prayers for things you DON'T want" (my yoga teacher wears a shirt that says that). Worrying is not productive. It is a waste of time and probably harmful. Look at what you can control (going to the doctor, following his reccomendations or seeiking a second opinion) versus what you can't control (what will happen, what will he want to do, etc). Put your energy into that which you can control and let go of that which you can't . Ask yourself the worst thing that can happen---and would you survive it. The best thing to do with your intrusive "what if " questions is simple: Answer them and move on. Good luck. I am sure it will work out fine.
posted by Lylo at 10:51 PM on August 24, 2007

I've had a mole looked at before on the advice of my GP, and the dermatologist took one look at it and knew what it was (non-cancerous). He was in an office that specialized in skin cancers, so he had extra experience and really knew these things inside and out, which I found comforting. They see moles of all kinds every day, and know what's normal and what's something that needs to be biopsied.

He also did a cursory exam of the skin on the rest of my body not covered by clothing, and on my scalp - apparently that's an area that gets more sun than we'd think, but doesn't get looked at closely on a regular basis. Finally, I had him remove a raised mole on my side that had been bothering me, getting knocked against things and whatnot, and that was a quick and painless procedure. You kind of have to take care of the area with a little extra effort for a while afterwards, but it's really not a big deal. If they remove the mole to biopsy it your experience may be somewhat similar.
posted by you're a kitty! at 11:26 PM on August 24, 2007

If you are worried about your appearance, ask to be referred to a plastic surgeon instead of having the dermatologist remove your mole. Dermatologists will generally shave off the mole, leaving a scar the full size of the mole, whereas a plastic surgeon can cut the mole out and suture the skin, leaving only a thin scar. The plastic surgeon will then send the removed mole for biopsy if directed by the dermatologist. I believe it's not a very expensive procedure vs. what your dermatologist would do.

Even if your mole is malignant, remember that there is an excellent chance of successful treatment if the changes have been noticed early, which it sounds like they have. Note also that some degree of mole growth is normal -- check instead to see if the colour or shape has changed.
posted by Krrrlson at 11:27 PM on August 24, 2007

Oh, one more thought: there are different kinds of skin cancer, and they're not all melanoma. In fact, most aren't, and non-melanoma skin cancers are highly treatable. So try not to worry too much!
posted by you're a kitty! at 11:33 PM on August 24, 2007

They may do a biopsy. Or they may just do a detailed inspection and say it looks fine but to let them know if there are any changes. I have a zillion moles, and the ones on my arms are all irregular which is normally a big concern. But a dermatologist once actually told me "The moles on your arms are bizarre. But they're uniformly bizarre. So I'm not going to worry about them." Sometimes they decide a biopsy is unnecessary.

Previously I have had one mole burned off and one sliced off. They give a general anesthetic for either procedure. I preferred having it cut off, it scarred less. YMMV. I have to get another one removed next month, but hey... that's what happens when you're nickname in jr. high was Mole Girl.
posted by miss lynnster at 11:44 PM on August 24, 2007

You shouldn't worry at all as worrying does nothing to change outcomes.

Your dermatologist will inspect your mole closely using good light and possibly a magnifier of some sort. If you are wearing foundation makeup, it will get swabbed off in that area so it's easier to just go bare-faced the morning of your appointment. If the dermatologist decides to remove the mole for biopsy, he or she will numb the area with a local anesthetic which--depending on the size of the mole--may just be a topical or a topical followed by a local anesthetic injection. The topical will feel cold, the injection, should you get one, will just feel like a tugging at your skin and a very very tiny pinprick (not painful, more of a pointy poking sensation). More tugging will ensue while the doctor scrapes/slices the mole off, along with reminders to hold your face very still while the doctor is wielding his tools on you. A small dressing will be applied: usually one of those little round dot band-aids of the color which matches no one's skin and you'll be reminded to avoid sunlight/wear sunscreen particularly while your wound heals (but don't dab sunscreen on the wound. That hurts. A lot.) The wound will heal quite quickly and is unlikely to be noticeable unless you are dark-skinned. You should get biopsy results fairly quickly, within the week.

If the doctor decides a biopsy isn't necessary, you may still elect to have the mole removed at that time. Most dermatologists will take it off and also remind you that the mole is likely to return in the exact same place. If you are prone to skin tags on your neck or shoulders, you can also request the dermatologist do a quick roundup of those, too. Unless you are inordinately taggy, this will add no more than a few minutes to your appointment. My dermatologist's billing sheet actually has preprinted checkboxes which stratify tag removal by quantity (1-10, 11-25, etc).
posted by jamaro at 12:11 AM on August 25, 2007

Family history may play a role in the treatment the doctor recommends. I have close relatives that have had malignant melanomas, and dermatologists have always recommended removal of any moles in hard-to-check places (back, scalp, etc.) when I or my siblings have been in to have them checked out. The one I've had removed was done painlessly without anesthetic; until reading this thread, I didn't realize that anesthetic was the norm.

(Hurray for the high standard of care at the college health service....)
posted by backupjesus at 5:08 AM on August 25, 2007

Make sure they look you over from the soles of your feet, to your genitals and scalp.

Buy a full length mirror and keep track of what's usually there.
posted by docpops at 6:31 AM on August 25, 2007

Some very good info in this thread, nthing "don't worry." It shouldn't be a big deal.

Here's my mole-removal stories, to give you some idea, although of course YMMV. (Note: the best part of all of this is that my dermatologist looks a lot like British television's Mr. Bean.)

I'm very prone to moles, and my dermatologist leans toward "better safe than sorry, when in doubt, remove it." I've had several removed. I don't think they've ever taken part of the mole for a biopsy, they've always just removed the whole thing in the first place. The first was on my back, and it ended up coming back in the middle of the scar, so it had to be removed again. The dermatologist did both surgeries himself. I ended up with a sizable scar, but I don't really care because it doesn't get seen that much. Both times it was a very short procedure with a local anesthetic, changing the bandages for a week or two afterwards was the only annoying part.

When it came time to remove some moles on my face (they didn't look that scary, but the derm said "if you were my daughter, I'd take them off just in case"), he recommended I go to a plastic surgeon. I asked around and interviewed a couple of surgeons, and was really happy with the one I picked. We did a "test run" with two moles near my hairline to see how they scarred, and you could barely see them, so we went ahead with the ones on my cheek. He used stitches, which surprised me in this age of surgical glues, etc., but apparently using stitches and taking them out after only a week keeps the scar small somehow. It made sense when he explained it, and it seems to have worked. After he took the stitches out I used these "Scar-Healing" bandages for a few months. I don't know if they helped, but they made me feel better, and they did probably protect the area from the sun, which is important. My scars are about as faint and unnoticeable as they could be.

Moral of the story: for a facial mole, definitely use the best plastic surgeon you can find. Also, the biopsies on all these moles came back normal, but normal moles can go bad, so I don't regret taking them off.
posted by doift at 7:19 AM on August 25, 2007

They give a general anesthetic for either procedure.

Are you shitting me?
posted by Krrrlson at 7:52 AM on August 25, 2007

When I went to have a mole (which had changed shape considerably) looked at, the doctor glanced at it, said it was probably nothing, numbed the area and sliced the mole off, dropped it on the floor, picked it up, and said if I didn't hear anything from them I would know I was all right. End of procedure.
posted by frobozz at 9:38 AM on August 25, 2007

In case those of you with many moles are feeling stigmatized by unjust Fate:

People with many moles may be more susceptible to skin cancer, but a new study suggests that their cells may age more slowly than those of people with fewer moles.

You all apparently have longer than average telomeres, which means your cells can divide more times to repair all kinds of damage before dying than those of people with shorter telomeres.
posted by jamjam at 9:45 AM on August 25, 2007

The only thing to be weary of, as in not worried but squicky, is the all-over body check. Be prepared for this when you go into the dermatologist. If you've got any questionable moles, you'll have to disrobe completely, and the doc will check everywhere. It's a good thing, but it's not exactly fun.

Anyway, even if the mole is bad, there are varying degrees of badness. So, as others said, don't worry too much about that.
posted by brina at 9:47 AM on August 25, 2007

and said if I didn't hear anything from them I would know I was all right.

NEVER, EVER, ever, ever accept "no news is good news" as a methodology of reporting results of pathology, labs, radiology, etc. I cannot emphasize this enough. No matter how well an office has implemented methods for tracking abnormal results, this is a huge source of missed findings that are later discovered when something terrible results months or years later.

We tell every patient to call if they do not get results conveyed within a week, and staff is not allowed to file any paperwork without a clear signature on it. And despite all that and more, we still catch "near-misses".
posted by docpops at 10:10 AM on August 25, 2007

They give a general anesthetic for either procedure.

Are you shitting me?

Not general anesthetic. They don't put you under.

I've had several moles taken off without any numbing, but with my most recent one, the physician's assistant used a tiny, tiny needle to apply a bit of numbing stuff directly to the spot -- my neck -- where she was going to cut. I didn't even feel the needle, and certainly didn't feel the cut.

And, yeah, I wouldn't worry. If you've never seen a dermatologist before, this is a good opportunity to get a medical eye to look over all your moles, not just the one that's of potential concern.
posted by bisesi at 11:03 AM on August 25, 2007

I recently had a mole on my face that was suspicious, and when a dermatologist checked it out she recommended doing a biopsy. Since my mole was flat, she used a punch biopsy with the smallest diameter that looked like it would get it all.

Later, I ended up needing to go back to a plastic surgeon to get the entire thing (underneath the skin) removed, since the results of the biopsy were somewhat unclear. However, having looked at both the scar from the punch biopsy and the scar from the plastic surgeon, I feel well-qualified to say that you shouldn't freak out about the look of a biopsied mole. It ends up being a round scar about the size of the mole itself, and by a few weeks later I had trouble telling it apart from the other moles on my face. (In fact, when the plastic surgeon later needed to take it off, he had such a hard time telling which one was a scar and which were just moles that he made me circle it with a magic marker so he didn't take off the wrong thing.)

All of which is to say, many dermatologists are of the "better safe than sorry" mindset when it comes to biopsies, and please don't let that freak you out. The scar if you have that done is very, very slight and ends up not looking much like a scar at all.

Good luck! Hope it's nothing.
posted by iminurmefi at 2:44 PM on August 25, 2007

Oh, and also something I found very comforting after my skin-cancer scare-- I heard a story on NPR (http://www.npr.org/templates/story/story.php?storyId=9968857) about how the rise in biopsies and diagnoses of melanoma have not correlated to an increase in deaths from the disease. It seems that we're screening for it a lot more, and diagnosing a lot more "pre-cancerous" moles, but that doesn't mean those would ever have developed into cancer. I had a sense of melanoma as this terrible, deadly cancer that no one recovered from, but it may be that in the past people just never caught it until it was too late to do anything. Now, with increased screening and more biopsies and mole removals, it turns out that melanoma isn't this death sentence that it may have been 20 years ago.

I hope that's helpful. I ended up very freaked out when it happened to me because it seemed like no one knew of any friends or family who had been diagnosed with a cancerous mole and hadn't had it be very serious; if I had known that it's becoming more common to have a diagnosis of precancerous moles I would have worried a little less. So get it taken care of, but don't worry too much about it.
posted by iminurmefi at 2:54 PM on August 25, 2007 [1 favorite has favorites]

This is not exactly what you asked, but do be prepared for a separate bill from the lab that examines the biopsy. Depending on how your insurance handles it, it could cost over $100 per mole. This is not to discourage you from going to the doc, but just so you're not surprised/outraged as I was.

Definitely since it's on your face, talk to your doctor about scarring. I had two moles taken off my back by my derm and they turned into raised, itchy, dark scars. I'm glad that they're gone but I would have asked about alternative removal methods had I known how they were going to turn out.
posted by radioamy at 11:05 AM on August 26, 2007