Biopsy and/or Removal of Nevus on Glans

[roughjack]

I have a small (5mm) light brown, flat mole on the head of my penis which developed from a small freckle about seven years ago.  (I'm 33.)  It took about two years to reach the size it is now and it has not grown noticeably for the past five years.  It is an even color with a semi-regular border.  It does not have any scaling or other irritation.  I have speculated that it is the result of a 2nd degree burn I received on my penis when a clumsy waiter spilled a pot of hot water on my crotch a couple years before the mole appeared.  I have many moles other places on my body.

I visited a dermatologist last year who told me not to worry about it.  But when I visited a urologist recently for an unrelated issue, he suggested that the mole needed to be biopsied and offered to do a punch biopsy in his office to determine whether or not is was cancerous or precancerous.

Given the extremely sensitive and cosmetically critical area affected by this mole, I am concerned about having any unecessary and disfiguring work done on the area.  But I am also concerned that it may turn out to be a problem later on.  I would like to evaulate it with a minimum of damage to the area.

I have three questions:

1)  What is the least damaging way for me to assess the potential malignancy of this mole?
2)  If it needs to be removed, are there any more careful procedures other than simple excision by scapel which would leave the area less disfigured?  I remember hearing once about a process which removes one layer of cells at a time and each layer is evaluated before another layer is removed to ensure the least amount of tissue is removed.  Would this work on the glans of my penis?
3)  How do I locate a doctor who is proficient at this sort of procedure?  Would he or she be a urologist or a dermatologist?

Thank you for your feedback.

[roughjack]

Thank you so much for your assistance.  I will schedule an appointment with another dermatologist for an evaluation.

[Alan Rockoff, MD]

Based on your description, you may well not need to remove the mole at all.

Moles on the palms, soles, and genitals, have the reputation of being at greater risk than other moles.  That's proobably why the urologist said what he did.  However, there is little data to back up this traditional statement, which is probably why the dermatologist said what he did.

My usual practice is to treat genital moles the same as any other: if they look funny, they come off, and if they don't look funny, they stay.  Given the fact that the mole is in plain view and you're sure it isn't changing, it probably is fine.

With pigmented lesions, however, it's best to be sure.  My advice is therefore to get another opinion--from a dermatologist (we look at moles not just take them off.)  If the verdict is to leave it alone, I'd do that and just follow it.  If not, a very superficial biopsy with minimal cosmetic implications should suffice.  That could be done by the dermatologist as well.

Best.

Dr. Rockoff