Laser mole removal - step by step: course, healing and scar

In my practice, the question I hear most often before removing a mole is: "will there be a scar?" Below I explain step by step what laser removal of moles in Wrocław looks like in the case of benign lesions, how long healing takes and what the final appearance of the skin depends on. However, I will start with the most important thing - not every mole can be removed with a laser.

What is a mole

A mole is the common name for a melanocytic nevus - a cluster of pigment cells (melanocytes) in the skin. Most moles are benign and do not require treatment, only observation [3]. The reason for removal may be discomfort (irritation by clothing, shaving) or aesthetic reasons.

The most important safety rule: when to use a laser and when to use a scalpel

The laser evaporates the tissue, so after the procedure there is no material left for histopathological examination. Therefore, only lesions that were previously assessed as benign are removed by laser [1,2]. If the mole is in any way suspicious, the appropriate route is surgical excision with histopathological examination - this examination remains the "gold standard" for diagnosis [3].

The ABCDE rule is used to assess moles: A - asymmetry, B - irregular edges, C - non-uniform colour, D - diameter over 6 mm, E - evolution, i.e. change over time. Any questionable mole requires medical evaluation before any decision to remove it [3].

How the CO2 laser works

The CO2 laser emits light with a wavelength of 10,600 nm, absorbed mainly by water contained in skin cells. The energy turns into heat, which precisely, layer by layer, evaporates the epidermis and superficial dermis [1]. Thanks to this, the procedure is less bloody and the doctor controls the depth of work. This is the same technology used in laser removal of skin tags and warts.

Laser mole removal - step by step

1. Consultation and qualification

Assessment of the lesion (clinically, dermatoscopically if necessary), interview, decision whether the laser is the right method. This is the moment when suspicious lesions are sent for excision with histopathology [2,3].

2. Local anaesthesia

The area is numbed locally, usually by injecting an anaesthetic drug. Thanks to this, the procedure itself is practically painless [2].

3. Laser treatment

The doctor vaporizes the lesion with successive beam passes, down to the level of the surrounding skin. The work is precise and small vessels are closed at the same time, which limits bleeding [1,2]. The treatment of a single mole usually takes several to several minutes.

4. Wound protection

A dressing/lubricating layer is applied to the wound. You receive care recommendations and an inspection date.

Healing - what to expect

• First days: slight swelling and redness, a scab forms. The skin is kept moist with a moisturising preparation [1].
• The scab: usually dries and falls off within about 7-10 days - we do not scratch it [2].
• Epidermalization: Regeneration of the epidermis occurs approximately within 1-2 weeks [1,2].
• Redness: a pink spot at the treatment site may persist for several weeks and gradually fade [1].

Scar and discolouration

In small, benign lesions, the laser scar is usually small and flat. Transient post-inflammatory hyperpigmentation may occur - more often in people with darker skin - which usually fades on its own within about 3-4 months [1,2]. Less often, there is lightening of the skin or, in the case of larger lesions, a small recess. The key to a good effect are: sun protection and patience in healing.

Contraindications

Laser removal is not performed, among others: in: lesions suspected of malignant nature (diagnostics first), active skin infection (e.g. herpes in the treatment area), tendency to develop keloid scars, recent isotretinoin treatment, as well as in tanned or sun-exposed skin [1]. Pregnancy and breastfeeding as well as some skin diseases require individual assessment.

Aftercare instructions

• Keep the area moist with the recommended lubricant until the scab falls off [1].
• Do not scratch the scab and do not soak the wound for the first few days [2].
• Protect the area from the sun - SPF filter min. 30, cover your head, avoid the sun in the afternoon. This is the most important prevention of discolouration [1].
• Report for a check-up and consult any disturbing symptoms (intensified pain, discharge, signs of infection).

Summary

Laser mole removal is a precise method for benign lesions, with short healing and usually a discreet mark. The condition for safety is the prior assessment of the mole - suspicious lesions belong to the surgeon and histopathologist, not to the laser.

Sources

1. Verma N, Yumeen S, Raggio BS. Ablative Laser Resurfacing. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. ncbi.nlm.nih.gov/books/NBK557474
2. Zhang LY, Zhang MX, Chen CY et al. Aesthetic removal of large melanocytic nevi using CO2 lasers with a programmed 4-step approach. Int J Clin Exp Med. 2018;11(6):6309-6315. full text (PDF)
3. Bodman MA, Al Aboud AM. Melanocytic Nevi. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. ncbi.nlm.nih.gov/books/NBK470451