During mole removal consultations at a skin clinic, there is something I hear more often than expected.

 

“Can’t you just burn it off with a CO2 laser?”

 

From the outside, it may look simple because it appears as a small, dark mole.

 

But in actual clinical practice, the word “mole” can include many different types of skin lesions.

 

It may be a melanocytic nevus, which is what we commonly call a mole.

It may also be a raised fibrous lesion, seborrheic keratosis that looks like an age spot, or a completely different condition such as a wart, milia, syringoma, or sebaceous hyperplasia.

 

That is why the most important question in mole removal is not “Can it be removed right away with a laser?”
It is first, “What kind of lesion is this?”

 

Even if lesions look similar to a mole, some can be removed superficially, some have deeper components and require discussion about recurrence, and some may need a biopsy before removal.

 

Today, I would like to explain how mole removal is performed, why we need to assess the depth and shape of the lesion first, and the pin-hole method concept that I consider important for reducing scarring :)

 

Some moles lie flat on the surface of the skin.

Some are slightly raised.

Some may have uneven color or blurry borders.

A typical benign mole often remains similar in shape for a long time.

 

However, if a lesion suddenly grows, has multiple colors, has irregular borders, bleeds, or repeatedly forms crusts, it should not be approached simply as cosmetic mole removal.

 

In these cases, the diagnosis should be checked first rather than immediately removing it with a laser.

 

Removing the mole is important, but confirming whether it is safe to remove is even more important.

 

Simply put, mole removal is not just a procedure.

It is a treatment that must begin with diagnosis.

If you look at the image above, moles are not always located only on the skin surface.

Their position can differ depending on depth.

 

Lesions located superficially near the epidermis may respond well to relatively shallow removal.

 

On the other hand, moles that extend deeper into the dermis may leave behind pigment or tissue that looks like a root if only the surface is lightly removed.

 

So with deeper moles, removing too deeply at once raises concerns about scarring, while removing too superficially raises concerns about recurrence.

 

This is where balance becomes important.

 

Mole removal is not about “burning it strongly so it ends cleanly.”

 

We need to decide how deeply to remove it, how much to leave while observing healing, and whether the risk of scarring or recurrence is greater.

 

Especially in areas such as the nose, around the mouth, chin, and temples, where there are many sebaceous glands or frequent movement, the healing pattern can be different.

 

This is why results can vary depending on the area and depth, even when the same CO2 laser is used.

 

One of the devices commonly used for mole removal in skin clinics is the CO2 laser.

 

The CO2 laser uses a 10,600 nm wavelength, which is absorbed by water in skin tissue and can be used to vaporize or ablate the lesion.

 

Simply put, instead of cutting with a scalpel, it removes lesion tissue very precisely using laser energy.

 

However, CO2 laser treatment still creates a wound in the skin.

 

A small wound forms where the laser passes, and new skin fills in as that wound heals.

 

During this process, redness, crusting, temporary pigmentation, indentation, or scarring may occur.

 

Especially when a mole is large or deep, the wound after removal can also become deeper.

That is why we need to assess not only the “size” of the mole, but also its “depth” and “location.”

One concept I often explain in mole removal is the pin-hole method.

 

As the name suggests, the pin-hole method approaches the lesion as if making multiple small holes.

 

If a mole is large or deep, removing the entire area widely and deeply at once can increase the wound size and the risk of scarring.

 

In such cases, rather than flattening and ablating the whole lesion at once, it may be helpful to create small holes at the required depth, induce a tissue response, and gradually reduce the lesion step by step.

 

In the literature, the pinhole method is described as a technique that uses CO2 or Er:YAG lasers to create small holes at 2–5 mm intervals, reaching from the epidermis to the deep dermis.

This method has been reported in cases of congenital melanocytic nevus and nevus sebaceous.

 

Another paper in Annals of Dermatology also described cases where the pinhole method was applied to congenital melanocytic nevus and nevus sebaceous, creating 1 mm holes down to the depth of the dermis.

 

Of course, this does not mean that every small facial mole should be removed using the pin-hole method.

 

The important point is the principle.

 

Wide ablation is not the only answer.

Depending on lesion depth and scar risk, selectively delivering energy can also be considered.

 

The reason I explain the pin-hole concept in mole removal is ultimately to reduce scarring.

 

The wider and deeper the wound, the higher the possibility of indentation, raised scarring, or residual discoloration during healing.

 

So for larger and deeper lesions, rather than trying to remove everything aggressively in one session, it is important to design the treatment safely within the range that the skin can recover from.

After mole removal, a small crust usually forms.

 

This crust is close to a natural protective layer that forms as the wound heals.

 

The problem is that many people want to remove the crust quickly.

 

If the crust is forcibly removed, skin that has not fully healed may be exposed.

This can prolong redness, increase the chance of pigmentation, or raise the risk of an indented scar.

 

So after mole removal, it is better to protect the area until the crust falls off naturally rather than intentionally picking it off.

 

In some cases, a healing dressing is applied.

In other cases, ointment is used to maintain a moist wound environment.

 

However, not every lesion requires the same aftercare.

 

The care method may vary depending on the size of the mole, removal depth, location, and skin type.

 

For example, a very superficial lesion may heal relatively quickly, while a deeper removal site may remain red for several weeks or longer.

 

Redness itself does not always mean something went wrong.

 

Some redness can appear as new skin fills in.

 

However, if the redness becomes increasingly severe, there is a lot of discharge, pain is significant, or the wound feels like it is opening, it should be checked.

One of the biggest concerns after mole removal is pigmentation.

 

Especially in Asian skin, inflammation after laser treatment can leave a brown mark.

 

This is called post-inflammatory hyperpigmentation, or PIH.

 

When the mole is gone but a brown mark remains in its place, patients may feel, “Did the mole come back?”

 

But recurrent mole tissue and pigmentation are different.

 

Recurrence means mole tissue has grown back.

Pigmentation is closer to a temporary increase in melanin during the wound healing process.

 

So when a brown mark appears after mole removal, it may be better to monitor the healing process and focus on UV protection rather than immediately treating the area again with a deeper laser.

 

Of course, if it is true recurrence, additional removal may be needed.

 

To distinguish between the two, we need to look at the shape, color, depth, and healing period of the treated area together.

There is also something important to remember.

 

Many lesions that people commonly call “moles” are not actually moles.

 

A flesh-colored raised lesion may be sebaceous hyperplasia, syringoma, or a fibrous papule.

A brown, rough, raised lesion may be seborrheic keratosis.

 

Small skin tags on the neck or underarms may be acrochordons, and rough lesions that spread on the surface may be warts.

 

These lesions differ in removal method, recurrence possibility, and aftercare.

 

From a clinician’s perspective, we first need to determine whether the lesion is a nevus, a keratotic lesion, a vascular lesion, or an infectious lesion.

 

If needed, a biopsy may be recommended.

 

Especially when a lesion has irregular color, suddenly grows, or changes in shape, diagnosis should come before cosmetic laser removal.

 

To reduce scarring after mole removal, three points are important.

 

First, the lesion must be assessed accurately.

 

The removal method differs depending on whether it is a mole, seborrheic keratosis, wart, or another type of lesion.

Second, the depth must be controlled.

 

If treatment is too shallow, tissue may remain.

If it is too deep, scarring may occur.

 

Third, aftercare must be done properly.

It is important not to pick off the crust, to avoid UV exposure, and to prevent the wound from drying out or becoming irritated.

 

Mole removal may seem short if we only look at the procedure time.

 

But the final result often depends more on the healing process afterward than on the procedure itself.

 

Especially for facial mole removal, even a small scar can be noticeable.

So rather than removing deeply at once without consideration, it is better to design the treatment according to the location and depth.

 

To summarize, mole removal at a skin clinic is not simply a procedure that burns off a mole.

 

We first need to determine what kind of lesion it really is, then check its depth and location, and remove it in a way that reduces the risk of scarring and recurrence.

 

CO2 laser is commonly used for mole removal, but the result is not determined by the device name alone.

 

The approach should differ depending on what kind of lesion it is, how deep it is, where it is located, and whether the skin is prone to pigmentation during healing.

 

Especially for large or deep lesions, a concept like the pin-hole method, which selectively controls depth, may be helpful compared with wide ablation without distinction.

 

In the end, what matters in mole removal is not “how strongly it is burned,” but “how accurately it is assessed and how much is removed only as needed.”

 

Even one small mole can feel quite noticeable when it is on the face.

 

That is why mole removal may look simple, but diagnosis and treatment design are very important :)

 

This was Director Won Dae-han.

 

Thank you for reading.

 

Source: https://anndermatol.org/pdf/10.5021/ad.2014.26.5.651

 

※ This article is intended to provide general medical information. Actual suitability for mole removal, removal method, number of treatments, and treatment intervals may vary depending on lesion type, depth, location, skin type, and previous treatment history. Lesions with irregular color or sudden growth may require diagnosis before laser removal. An accurate diagnosis and treatment plan should be determined through consultation.