What is a Suspicious Lesion?

Suspicious lesions are moles, growths, or brown spots that are typically benign (non-cancerous), but can be at risk for cancer transformation. A suspicious lesion can be a pigmented lesion or non-pigmented lesion. Suspicious pigmented lesions are of concern as they can transform from a normal mole into an atypical mole, or worse, into malignant melanoma. Malignant melanoma is of concern as it is the leading cause of skin cancer deaths in the world. Several factors have been defined to help identify suspicious pigmented lesions and these include:

  1. Asymmetry: Draw a line down the middle of your lesion, check if appearance of one half does not match the other. If the two sides do not match then they are asymmetrical, which is a warning sign for malignant transformation.
  2. Border Irregularity: Benign moles have smooth and even borders. If your mole has uneven, blurred, or jagged borders you should be checked by a medical professional to rule out an atypical mole or worse a melanoma.
  3. Color: Check the color of your lesion. Most benign moles tend to be a single shade of light brown. If the mole has an uneven, two tone color variation(termed variegated), or if it is very dark you may be at risk for melanoma.
  4. Diameter: Observe any change in size of your lesion, any mole larger than the size of a pencil eraser (about 6mm, or ¼ inch) should be evaluated by a medical professional.
  5. Evolution: It is important to check your current moles for change or evolution. If there is any change in shape, size, color, or any other trait such as the development of tenderness, itchiness, or bleeding make an appointment with your medical professional.

Non-pigmented suspicious lesions are typically of two varieties: Basaloid cells or squamous variety cells that can potentially transform to Basal Cell Carcinoma (BCC) or a Squamous Cell Carcinoma (SCC). Basal cell carcinomas will typically develop as a small nodular growth (termed papule), will be itchy or scaly. They typically appear on the upper and lower limbs, face, neck, scalp, nose, ears, and/or eyelids and do not fade away and continue to grow unlike acne lesions (which fade after 1 week of popping up). Squamous Cell Carcinoma lesions will typically appear as flat and/or raised lesions, will be flaky and itchy. These lesions typically appear on the face and forehead, lips, upper and lower limbs, chest, and back. SCC lesions are more concerning that BCC lesions as SCC lesions have the capacity to metastasize and thus be potentially deadly. The goal of identifying non-pigmented cells is to avoid transformation of premalignant lesions such as an actinic keratosis lesion (in the squamous cell line) into dangerous malignant lesions.

Treating Suspicious Lesions

The surgical treatment for suspicious lesions involves one of two techniques that is determined by the color of the lesion. Patients with suspicious non-pigmented (non-colored) lesions are offered a shave biopsy in order to obtain a diagnosis. Shave biopsies involve cleansing of the skin with a topical alcohol or sterilizing solution. The area or lesion to be biopsied is anesthetized with local anesthetic (lidocaine with epinephrine) solution similar to when one gets numbed at the dentist’s office. Next, a shaving tool is used to shave a small piece of the lesion so that it may be analyzed by a pathologist. Since the removal of tissue is limited to the superficial most layers of skin, the ensuing wound is able to heal itself without the need of stitches. Any bleeding is temporized by using a hemostatic solution called Drysol. The superficial wound is dressed with an antibiotic ointment such as Bacitracin and a Band Aid. the area will typically heal within 48 hours. In contrast, patients with pigmented (colored) lesions may be offered a punch biopsy in order to obtain a diagnosis. Punch biopsies involve cleansing of the skin with a sterilizing solution such as Hibiclens. The lesion to be biopsied is anesthetized with local anesthetic solution as above and a special cylindrical tool is used to obtain a full thickness skin specimen with its underlying fat tissue core. Since this wound is deeper, it does typically require a single stitch. However, the the resulting incision stab is very tolerable due to the small size of the biopsy diameter (between 2 to 3mm).

How our patients feel about us:

As comfortable as possible... I have had multiple skin cancer spots surgically removed by Dr. Mowlavi. I have been to several other doctors for the same procedure, and having met Dr. Mowlavi and his staff I have fought with my medical group to continue to send me to only Dr. Mowlavi. Not only is he understanding and explains the procedure from beginning to end but they make you feel as comfortable as possible. The entire staff is friendly and always on time for my appointments.

Linda B. Long Beach, CA

He treats us like family... My experience with Dr. Mowlavi, caring for my mother, was very positive. He and his staff work together making us feel comfortable and confident in their care. He is always available to help. He treats us like family and has our full trust in his care. He explains everything and takes time to answer our questions. His surgical skills are amazing and we are pleased with the results. I would highly recommend Dr. Mowlavi.

Maureen H. Laguna Beach, CA

Care at a very high professional level... Everyone from the staff to the doctors provided care at a very high professional level. It had been quite awhile since I received such personal care and follow-up attention from a medical office. Thanks to your wonderful staff.

Kathy B. Laguna Beach, CA

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