What is the appropriate treatment for a bleeding mole in an adult patient with no known bleeding disorders or anticoagulant use?

Treatment of a Bleeding Mole

Apply firm, sustained direct pressure to the bleeding mole with sterile gauze for 10-15 minutes, which controls bleeding in the vast majority of cases, then elevate the area if possible to reduce venous pressure. 1

Immediate Hemorrhage Control

• Apply continuous direct pressure with sterile gauze or clean cloth directly to the bleeding mole for at least 10-15 minutes without interruption to allow clot formation 1, 2
• Maintain pressure without lifting to check if bleeding has stopped, as premature removal disrupts clot formation 2
• Elevate the affected area above heart level if anatomically feasible (e.g., arm or leg) to reduce venous pressure and facilitate hemostasis 1
• If direct pressure alone fails after 10-15 minutes, apply topical vasoconstrictors such as oxymetazoline or epinephrine-soaked gauze directly to the site, which achieves hemorrhage control in 65-75% of cases through local vasoconstriction 2, 3
• Leave vasoconstrictor-soaked gauze in place for 10-15 minutes while maintaining external pressure 2

Assessment During Bleeding Control

While applying pressure, systematically evaluate:

• Hemodynamic status: Check vital signs including blood pressure and heart rate to identify signs of significant blood loss 1
• Medication review: Determine if the patient is taking anticoagulants (warfarin, DOACs) or antiplatelet agents (aspirin, clopidogrel), as these significantly increase bleeding risk 1, 3
• Bleeding characteristics: Assess whether this represents minor oozing versus brisk bleeding, and estimate blood loss volume 2, 4
• Duration of bleeding: Document how long bleeding has been occurring 2

Management Based on Anticoagulation Status

For Patients NOT on Anticoagulants:

• Continue local pressure measures as primary therapy 1
• Most bleeding from benign skin lesions stops with sustained pressure alone 1, 2

For Patients on Anticoagulants (Non-Major Bleeding):

• Do NOT routinely discontinue anticoagulation for minor bleeding, as local control is sufficient and stopping increases thrombotic risk without improving outcomes 3
• Continue direct pressure and topical vasoconstrictors as first-line therapy 3
• Temporary withholding of the next dose may be considered only if bleeding persists despite adequate local measures 5

For Major Bleeding (Hemodynamic Instability or Uncontrolled):

• Discontinue anticoagulants immediately 5
• Provide aggressive volume resuscitation with isotonic crystalloids (0.9% NaCl or Ringer's lactate) 5
• Consider reversal agents if bleeding is life-threatening and patient is on oral anticoagulants 5, 3

When Local Measures Fail

If bleeding cannot be controlled with 15-30 minutes of direct pressure and topical vasoconstrictors:

• Apply hemostatic gauze or packing to the site if there is a cavity or deeper tissue involvement 2
• Seek urgent medical evaluation for potential cauterization or surgical intervention 2
• Consider that persistent bleeding may indicate a vascular lesion requiring definitive treatment 2

Critical Pitfalls to Avoid

• Do not attempt cauterization as a first-line measure without adequate hemostasis, as this may worsen bleeding 2
• Do not discontinue anticoagulation without consulting the prescribing physician unless bleeding is life-threatening, as first-line local measures should be attempted first 2, 3
• Do not repeatedly lift the gauze to check if bleeding has stopped during the initial 10-15 minutes, as this disrupts clot formation 2
• Do not use non-resorbable packing in patients on anticoagulation, as removal may precipitate rebleeding 2

Indications for Urgent Medical Referral

• Bleeding persists beyond 30 minutes despite appropriate local measures 2
• Signs of hemodynamic instability (hypotension, tachycardia, dizziness) 1
• Hemoglobin drop ≥2 g/dL or need for blood transfusion 3
• Recurrent bleeding episodes requiring multiple interventions 2
• Concern for malignant transformation (irregular borders, color changes, rapid growth) requiring biopsy 4

Post-Hemostasis Management

Once bleeding is controlled:

• Apply a pressure dressing over the site 2
• Instruct the patient to avoid trauma to the area, straining, or activities that increase blood pressure to the region 3
• Arrange dermatology evaluation for definitive assessment and potential removal of the mole, as bleeding may indicate trauma, irritation, or rarely malignant change 4
• For patients on anticoagulation with recurrent bleeding, coordinate with the prescribing physician regarding risk-benefit of continued therapy 3