What you need to know about mole removal!

Recently, a young lady with many moles came to me for a second opinion.  She has had her mole checked as well as laser mole removal done by another doctor. However, her mole specimens which were sent for laboratory analysis were reported to be too tiny, charred and inadequate for proper evaluation for the exclusion of skin cancer. Understandably, she was anxious!

After clinical consultation and examination, I concluded that her risk for skin cancer was low and all her remaining moles were normal looking. All her moles could have been removed without the need to send specimens for laboratory analysis. I then assured her that it was likely that the moles removed earlier were also normal too. With that assurance, she left the clinic happy and in peace.

Moles are common and generally not attractive. Most people would like to have them removed. In Singapore, this treatment is performed by a myriad of people, accredited skin specialist, beauticians in beauty salons and even some uncles at the night bazaar stall. Very often, people expect mole removal to be risk-free and they do not consider it necessary to have it examined or removed by a skin specialist. They assume that the skin will heal perfectly.

Many people are not aware that scars, indentations and colour changes may occur after mole removal procedures. The moles can also recur when there is incomplete removal. The worst-case scenario is when a cancerous mole was removed unknowingly and incompletely. That would have been disastrous and that was why the patient above was anxious!

When a patient comes for mole removal. I will evaluate their risk factors: skin type, past histories of skin cancer in the patient and family, history of occupational and recreational sun exposure and etc. If they are assessed to be of low risk, then I will remove their normal looking moles upon request. There is no need for any laboratory analysis. But if they are assessed to be of moderate or high risk, I will surgically remove the suspicious moles and send them for laboratory testing. It is important to be prudent and careful even with simple procedures like mole removal.

Viral warts – the illegal immigrants on our skin

Warts are common and they are a type of skin infection. Warts are caused by virus, Human papillomavirus (HPV) to be specific. One British Professor of Dermatology once quipped that dermatologists are kept gainfully employed because of warts!

Indeed, as a dermatologist, I see patients with wart weekly, sometimes even daily. Patients are concerned if the warty growths they have are cancerous? Why and how did they get them? Will it spread to their family members? Quite a few are conscious that they are carrying a skin infection!

Many have tried all kinds of self-remedy. Often, they have tried with limited success by the time they come to see me. Yet, many do not realize that their own immunity is a critical player in eradicating warts and dermatologists are just facilitating the healing process when they administer the treatments strategically.

For those who know me, I often use metaphors to explain the medical problems to my patients. Our immune system is like our security troopers. They patrol our body and keep it safe from intruders like viruses and bacteria. The existence of the wart indicates that the HPV have somehow managed to stay in the skin as “illegal immigrants” escaping the detection of our immune system. Administering treatments like topical lotions, freezing treatment and laser, I am trying to alert and jolt the immune system into action. The wart can be eradicated only when the immune system swings into action and kills the virus with antibodies.

A young Caucasian boy was traumatized by repeated freezing treatments because of its associated pain. When his father brought him to see me for a change, I explained to him the principle behind the treatment strategy and that I would dispense only topical treatment to spare his son the agony of pain. After 6 months of treatments, all the 30 or so warts that scattered on his face, neck, arms and fingers were all eradicated! I did the same approach to another young girl’s warts on her thumb and got rid of them after several weeks!

Although topical treatments are painless, they are quite tedious to follow when there are many warts. Not all patients who are on topical treatments end up with great success stories like those alluded to above. Freezing treatment is still the treatment of choice for many dermatologists, including myself.

I remember 2 Italian patients well. The first was an Italian male adult with 30 warts on both his soles for more than 10 years. The warts were a mixed collection of big and small lesions. I asked him to identify for me the “Godfathers “, the patriarch of the lot! I froze 5 of the patriarch lesions hard with freezing treatment. 2 months later, the patient came back smiling, reporting that all the warts have gone for good! “The warts just crumbled down like powders!”, said the patient.

Another Italian patient was a teenager, who was brought to see me by his mother. He had literally hundreds of warts on his lower abdomen and supra-pubic area. After identifying the “God father” of the lot, I treated 12 warts hard and behold, all the rest of the warts resolved gradually in the ensuing weeks! In these 2 examples, I merely initiated the process by treating the selected warts, the good results were the work of the patients’ own immune reactions.

Some patients’ responses are dramatic while others’ are a long drawn affair. Spending time explaining to patients, helping them to understand the treatment rationale are important as treatment of warts requires patience, from both patient and doctor. With patience, experience and a bit of luck, I set out to help all my patients to initiate the amazing healing process that our body is capable of achieving!