About the Surgical Excision of Moles and Cysts

MOLES

Moles can take many different forms, and can be found in many places on the body. There are several different types of moles, which differ both in their appearance, as well as where the mole cells are specifically located in the skin. Some of the more common moles include:

• • • Dermal moles: These are usually soft, skin colored, and raised above the surface of the skin.
    • Junctional moles: These are usually completely flat, small, and dark brown in color.
    • Compound moles: These will usually have both flat and raised components to them (a cross between a dermal and a junctional mole), and can range in color from tan to dark brown.
    • Blue mole: These moles are blue-gray or blue back in color, and tend to be more commonly found on the face, scalp, hands, and feet. Although blue moles can be found on anyone, they tend to be more common in individuals of Asian descent.

The options for treating moles include surgical excision, laser treatments, or simple observation if the appearance and behavior of the mole are benign.

CYSTS

Like moles, cysts also come in different varieties, and can be found in many different locations on the body. Most cysts contain keratin (what our skin and hair is made of), oil (sebum), or very often both. Because a cyst consists of a sac that is lined by cells or glands that create its contents, definitive treatment requires complete surgical excision of both. Some common types of cysts include:

• • • Epidermal inclusion cyst: This is the most common type of cyst. These cysts will often have a connection to the skin’s surface (a small punctum or opening that you can see overlying the cyst), through which a white, cheesy, malodorous substance can often be expressed. Epidermal inclusion cysts can be found nearly everywhere on the body, including on the genitals.
    • Pilar cyst: This cyst is made out of hair follicle elements, and as a result is found on the scalp. Some people will have a tendency to develop multiple pilar cysts.
    • Dermoid cyst: This type of cyst arises as a result of an alteration in fetal development that traps ectodermal elements – such as skin cells, sweat glands, oil glands, and sometimes hair follicles. Dermoid cysts are often first observed at birth or shortly thereafter, and are usually located on the head. Because these cysts may have an intracranial connection, it is important to obtain appropriate imaging prior to surgical excision.
    • Steatocystoma: A steatocystoma is similar to an epidermal inclusion cyst, but instead has a sac that is lined with sebaceous (oil) glands. Consequently, a steatocystoma will contain an oily substance, rather than the keratinaceous material that is found in other types of cysts. When a person develops several of these cysts, the condition is known as steatocystoma multiplex. While steatocystoma multiplex can occur randomly, some people will develop these as the result of an autosomal dominant mutation, in which case a person will report that one (or even both) of their parents had similar cysts. The treatment for a solitary steatocystoma is surgical excision, while laser ablation is a more appropriate option for steatocystoma multiplex, as described here.
    • Vellus hair cyst: This is a cyst that contains small vellus hairs in it, in addition to keratin and sebum. Some people may develop multiple cysts in a short period of time, referred to as eruptive vellus hair cysts. The treatment for a solitary vellus hair cyst is surgical excision, while laser ablation is a more appropriate option for eruptive vellus hair cysts, as described here.
    • Scrotal calcinosis: This occurs when small, firm, flesh colored to whitish/yellow nodules appear on the skin of the scrotum. Although these cysts are benign, individuals affected are often bothered by their appearance, and will hence elect to have them surgically removed.

Which moles or cysts are good candidates for surgical excision?

Many people will seek to have certain moles removed simply because they do not like the appearance of them. Moles that have cells that are situated in the deeper layers of your skin – such as dermal moles, compound moles, and blue moles – require surgical excision in order to prevent their recurrence. In some cases, a mole that has recently exhibited a change in size, color, shape, symmetry, or that has become symptomatic in some way, should also be removed so that it can be sent for histopathologic study to determine whether its cells are atypical or even cancerous.

As is the case with moles, many people will have their cysts removed because they do not like the appearance of them. Other reasons why a cyst should be surgically excised include  increasing size, and/or a history of becoming infected/inflamed.

Can I remove my moles or cysts with a laser treatment instead?

Depending on the type of mole you are looking to have treated, it may be possible to avoid surgery in favor of a laser treatment. The first step in making this determination is to have your moles closely examined by one of our board-certified dermatologists, who can assess the type of moles you have, whether these moles have any atypical features that would warrant a biopsy, as well as whether a laser treatment is a viable option. Our dermatologists will also determine whether the spots you are looking to have treated are truly moles, or whether they are other types of benign pigmented spots such as seborrheic keratoses, dermatosis papulosis nigra, sun spots, post-inflammatory hyperpigmentation, or melasma. Fundamentally – not all brown spots are moles, and not all moles can be treated with laser!

In contrast, the majority of cysts require surgical excision in order to be definitively treated. Exceptions to this include conditions such as steatocystoma multiplex and eruptive vellus hair cysts which are often better treated with ablative laser.

What happens if I don’t treat my moles or cysts?

In the majority of cases, it is completely fine to not treat your moles or cysts. However, if your cyst has a history of becoming infected/inflamed, and/or has required multiple incision and drainage procedures in the past, surgical excision may be a preferable option. Many moles can also be left untreated, but if any start to exhibit changes in color, border, size, shape, or other new symptoms, our board-certified dermatologists may recommend surgical excision so that the mole can be sent for evaluation.

Why trust Gateway Aesthetic Institute and Laser Center to treat my moles or cysts?

At the Gateway Aesthetic Institute and Laser Center, our board-certified dermatologists will conduct a careful evaluation of the areas that you are looking to have treated, prior to initiating any intervention. This is important because some moles and even cysts may exhibit features concerning for malignant transformation. Once this has been ruled out, they will counsel you on treatment options, which range from surgery, to laser ablation, to observation – taking into account the size and extent of the areas that you are looking to have treated, your personal and family medical history, as well as your preferences for treatment.

In addition to their expertise when evaluating your skin, our dermatologists at the Gateway Aesthetic Institute and Laser Center are highly experienced skin surgery specialists, who pride themselves on obtaining excellent cosmetic outcomes for all excisions that they perform. Our wide array of state of the art lasers further provides our physicians with the choice of performing your surgery with a scalpel or a CO2 laser, as well as improving the appearance of your surgical scar if that is something you desire. With our numerous treatment options, the surgical skill of our board-certified dermatologists, and our advanced laser technology, the Gateway Aesthetic Institute and Laser Center can offer you safe, efficacious, customized, and complete treatment of your moles and cysts.