Experiences with Moles (Melanocytic Nevi)

Miscellaneous and Personal Stuff I Must Share
1

So a few weeks ago I finally got around to making an appointment with a dermatologist to have a really annoying raised mole near my one armpit removed and also have a suspicious looking flat mole on my one outer thigh looked at. The dermatologist agreed that the on my thigh was suspicious enough to merit a biopsy, so she did that and removed the one on my armpit during that visit.

A few days later I got a phone call saying that the one on my thigh was an atypical nevus (precancerous but not cancer), but I needed to schedule surgery to have an excision because the abnormal cells went to the margin of the biopsy sample. Oh joy!

This particular dermatologist only does surgicals on Tuesdays, and only 2 per Tuesday at that, so I’m not scheduled to go back for the excision until a week from Tuesday.

This delay has given me plenty of time to scour the Internet and consequently to freak myself out about having a chunk of my flesh down to the fat excised with a sharp, sharp scalpel. Before the earlier biopsy, the dermatologist (actually she’s a certified Physician Assistant) gave me a shot of lidocaine, but I still felt some sharp pains during the quick shave biopsy that she performed. I’ve been worrying myself sick that this more involved procedure is going to be very painful and unpleasant. I can tolerate a few sharp pains, but a bunch of them for an extended procedure will make me want to gnaw my leg off (which I understand would also be painful).

I’d be interested in hearing about other peoples’ experiences with skin excisions, especially if you had to go back for a second procedure after an initial biopsy in order to be sure everything nasty was removed.

Is it common practice for the dermatologist to perform a field block with anesthesia?

I have some oxycodone leftover from when I had a kidney stone a few years ago–should I take some before the procedure?

How large a chunk of my flesh is likely to be removed? This was initially a mole only about the size of a typical average freckle.

On top of this, a few inches away is another flat mole that looks similar to this one only smaller, and there is another one on my left shoulder that also looks strange to me. Ugh! I am never going outside again!

2

I’ve had several raised moles removed. I’ve never had a mole biopsied before removal.

The PA injected each mole with a topical anesthetic, and by the time he’d injected the last one, the first one was ready to be cut out. I had a lot of bleeding with a couple of the moles, and he zapped the wounds with an electric needle to stop the flow. I had a teensy bit of pain after the anesthetic wore off, but not enough to take anything for it.

I don’t know how long oxycodone is good for. If you’re driving yourself, don’t take it until after you get home. If you take an NSAID, you’ll likely bleed more than you normally would. Since you have plenty of time before the appointment, call the office and ask about pre-procedure painkillers.

My husband had a flat mole removed, and he was more annoyed with having to wear a bandage than any pain involved. He experienced more pain from the anesthetic injection than he did from the actual removal.

3

I had a flat mole removed (haloed nevus, which ended up having precancerous changes - whole mole removal was done, then biopsy) that was anesthetized with local injections. Didn’t feel a thing other than a little tugging of the skin well around that area. Later on I was uncomfortable but not in any significant pain; they gave me a list of what OTC medications were and weren’t allowed (due to bleeding issues), and I don’t think I took anything.

4

I’ve had several moles removed, with varying levels of complications.

The procedures themselves were always painless–I got injections of anesthetic around the perimeter of the area, so I just felt a bunch of tugging and pressure during the procedure. The cauterization smelled kind of like burning hair.

Don’t bother with the oxycodone–you’ll probably be fine with OTC Tylenol. My dermatologist gave me a prescription for T3s just in case, and I ended up using one once because a couple of my procedures were in awkward spots on my arm and shoulder, so it was hard for me to sleep. But since yours is on your thigh, you’ll probably be fine. If you’re one of those people who thrashes around during the night, though, you may want to arrange a bunch of pillows to keep you from rolling over.

Regarding the size, it depends on the procedure, but the guideline was they want to get the nevus and about 5mm of clear skin around it. For a “shaving” procedure, I ended up losing a piece, I dunno, about the size of a dime. For an “excision-n-stitches” procedure, the dermatologist had to take out a larger piece of skin in order to get the edges of the wound to meet up so they could be stitched–so the wound was like a very tapered ellipse a couple inches long. There were a couple layers of stitches involved–some internal ones that dissolve, and a few external ones that had to be removed a couple weeks later.

In terms of stuff to be paranoid about, there is a chance of infection, so keep an eye on it and contact your doctor if necessary. This happened to me and it wasn’t a whole lot of fun, but fixing it was reasonably straightforward; I ended up having to take some oral antibiotics and apply topical antibiotics for a while.

Regarding going back for a second procedure after a biopsy, I actually still have some tape on my left arm from one of those. The dermatologist did a standard excision, and it healed beautifully, then the biopsy results came back and it turned out that I needed to get another chunk removed. So I went back, got it removed, and ran into some issues with healing. Because a lot of skin was removed in a relatively short period of time, and there’s not a lot of extra room in the particular area where it happened, I ended up with some tension that tended to pull the wound open so it healed very slowly. This helped lead to some other problems in which my body gradually rejected some of the internal stitching (they ended up migrating to the surface of the wound), so I had to go back again and get them removed. So this sounds kinda gross, but the real impact is more on a “jeez, what a PITA” level, not an “ohmigod I’m gonna die” level.

Asides from that, just be sure to get instructions for appropriate post-op care from your doctor.

5

Hopefully Typo Knig will pop in with his experience: mole removed that turned out to be stage 0 melanoma and they took a bigger slice a few weeks later to get better margins. Almost exactly what you’re having done.

IIRC, he didn’t complain about the second procedure at all (and I was in the room so I’d have heard).

I suspect the first time, the PA didn’t allow enough time for the lido to kick in, and/or didn’t inject it in the correct spot. Will the actual dermatologist be doing the next procedure?

6

Here are threads on this topic in the last year:

[thread=528568]Moles, doctors, lab results, and the modern man. A medical inquiry.[/thread] August 2009

[thread=529850]What to expect for a mole check with a dermatologist?[/thread] August 2009

[thread=507754]Should I be concerned about this bump/mole?[/thread] February 2009

When I had my bad mole removed, the dermatologist wanted to take more of me to make sure he had clear borders - both in width and depth. That was an office procedure with local injected anesthetic. I don’t recall that it hurt a bit. And I’m a wuss! I have a small scar on my upper arm, and I need a good story to go with it.

General advice: Do NOT take any meds before your procedure without consulting with your doctor. Note that I am not a doctor, and I am not your doctor.

Call your dermatologist and ask all of your questions. Have the other moles looked at. The dermatologist can tell you if they are OK or suspicious.

Relax, it will be OK.

7

I had an early stage in situ melanoma cut out of my cheek. The spot itself wasn’t that big, maybe pencil-eraser size. The MOHS surgeon was rather “generous” when he cut around the margin, resulting in an almost dime-sized chunk being removed. They used ample amounts of lidocaine, and I didn’t feel a thing. They gave me Vicodin to hold me over until the next day, and it worked perfectly well.

When I went to the plastic surgeon the next day, he said they almost nicked a saliva gland. But the margins were clean, which is what really mattered. The plasic surgeon used lidocaine again, and all I felt were assorted tugs and pulls. Afterwards, the Vicodin kept the pain at bay–to a dull ache, mostly. Actually the worst part was being shown a photo of the wound–it looked like someone had used a small melon ball on my cheek. I still get shivers when I remember looking at that polaroid…yikes.

8

I’m glad to hear that the general consensus is that this procedure shouldn’t hurt. I guess I just had a bad experience (well not exactly bad, but bad enough) the first time and so have been dreading the full excision procedure. The physician assistant is doing the second one as well. The idea of having a chunk of my integument removed is just unsettling to me, ahh… on the surface! I won’t be watching the progress of the procedure and I am sure I don’t even want to see the removed portion afterwards! I’m also hoping I don’t end of with a 2-inch long scar.

I’m also concerned that of all the moles and freckles on my body–and I’m guessing there are at least a 100 such things–that the one I specifically went to the dermatologist to see came back as atypical. I’m certainly not an expert at identifying bad moles! It scares me to think there might be others. The PA did check and didn’t note anything else, but it was a quick check, I didn’t even have to strip.

9

Well, they’ll have it all stitched together by the time you’ll be able to/want to look - you won’t see this big removed area or anything. I ended up with about an inch long scar on my chest from where mine was removed - it’s very thin, but you can see some puckering and spots around it where the stitching was done. The closure style will probably vary depending on where it is; mine wasn’t in a very “high tension” area.