Prophylactic Excision of All Benign Moles Is Not Recommended
No, you should not surgically excise all benign moles, even to prevent melanoma—this approach is neither clinically necessary nor cost-effective. 1, 2
Evidence-Based Rationale
Why Prophylactic Excision Is Not Indicated
Prophylactic excision of benign nevi or small (< 5 cm diameter) congenital nevi in the absence of suspicious features is explicitly not recommended by UK dermatology guidelines. 1 The evidence supporting this recommendation includes:
Individual benign moles have an extremely low transformation risk - the likelihood that any single benign nevus will undergo malignant transformation to melanoma is vanishingly small 2, 3
Removing all atypical moles is neither necessary nor cost-effective, even in higher-risk populations 2
Prophylactic excision of all atypical nevi is not recommended even in patients with atypical mole syndrome who are at increased melanoma risk 4
The Correct Approach: Surveillance Over Surgery
The appropriate strategy focuses on surveillance and selective excision rather than prophylactic removal 1:
For average-risk patients:
- Perform monthly skin self-examination looking for ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution/change) 5, 3
- Seek evaluation for any new, changing, or irregularly pigmented lesions 6
For high-risk patients (atypical mole phenotype, previous melanoma, family history, organ transplant recipients):
- Teach self-examination techniques 1
- Perform periodic dermatologic surveillance every 6-12 months 5
- Use baseline photography to document lesions and detect changes over time 1, 5
When Excision IS Indicated
Only excise moles that demonstrate concerning features 1:
- Clinical suspicion of melanoma based on ABCDE criteria 1, 3
- The "ugly duckling" sign - a lesion that looks different from the patient's other moles 3
- Concerning changes: rapid growth, darkening, bleeding, ulceration, or nodule development 7, 5
- Severely atypical nevi on biopsy require complete excision due to higher melanoma association 7
Proper Excision Technique When Indicated
When a lesion requires removal 1:
- Perform complete excisional biopsy with 2mm clinical margin of normal skin and a cuff of fat 1
- Orient the excision axis to facilitate possible subsequent wide excision (typically along the long axis on limbs) 1
- Never perform diagnostic shave biopsies on suspicious lesions—they lead to sampling error and prevent accurate staging 1, 5
- Avoid partial removal of melanocytic nevi, which can create a pseudomelanoma picture causing diagnostic confusion 1, 7
Critical Pitfalls to Avoid
- Do not remove all moles "just to be safe" - this creates unnecessary surgical morbidity, scarring, and healthcare costs without improving outcomes 2, 4
- Do not use shave biopsy for suspicious pigmented lesions - complete excision is required for accurate diagnosis 1, 5
- Do not ignore changing lesions - evolution is the most important warning sign requiring evaluation 1, 3
Special Populations Requiring Enhanced Surveillance
Refer to dermatology for ongoing surveillance (not prophylactic excision) 1, 5:
- Patients with atypical mole phenotype
- Previous personal history of melanoma
- Family history of 2+ melanomas
- Giant congenital pigmented nevi
- Organ transplant recipients
The bottom line: Melanoma prevention relies on surveillance, sun protection, and selective excision of suspicious lesions—not prophylactic removal of all benign moles. 1, 2, 6