Question

My 22-month-old Caucasian son has a thumb-print-size mole, which is bumped and hairy, on his jawline. At the suggestion of a pediatrician, we are seeing a cosmetic surgeon to see about its removal (the pediatrician cited potential bullying at school later in life as the reason for removal), but I¿m not sure about removing it. I¿d rather he had a mole that may fade than a scar. Is the area likely to scar badly? How traumatic an operation would it be for my son (more traumatic than bullying, which may not occur)? In the meantime, we are very careful to cover the mole with plenty of sunscreen when he is out and to have him wear a brimmed hat in the sun.

Answer

You bring up several important issues. Although you don't mention the duration of the mole, I assume it was present at birth or within the first few months of life. We call these congenital moles and approach them a bit differently than those that are acquired later in life. Congenital moles have a slightly increased risk of melanoma, one type of skin cancer. In large congenital moles (those whose diameters are more than 20 centimeters), this risk may be significant, and surgery is frequently recommended. However, in smaller congenital moles (those moles that are under 1 or 2 cm in size, like your son's), this risk is minimally higher than the risk in the general population.

Therefore, if these moles look benign -- if they have sharp borders and even pigmentation, for instance -- then following them over time is an appropriate option, and the primary reason for surgical removal becomes cosmetic. When judging the cosmetic significance of the mole, many factors need to be considered, including location of the mole, its "unsightliness," the age of the child, and his personality type. Your concern about scarring is valid, as no surgery is scarless. However, a good pediatric plastic surgeon with experience in congenital mole removal can usually offer an excellent cosmetic result. And the surgery should not be significantly traumatic, as young children are given general anesthesia for such procedures. On the flip side, although some children are teased and taunted about a mole, many are able to very effectively cope with their 'beauty mark' throughout the school years.

This decision is a complex and quite personal one. Don't rush it, and be sure all of your questions are answered. And should you decide to leave the mole alone, continue your excellent habits of sun protection. If you ever notice any significant changes in the mole, have your son evaluated by his physician. Good luck.