Fatimah Ghalib Mahdi Al-Najjar (1)
Cutaneous melanocytic Nev commonly referred to as moles are among the most frequently encountered skin lesions in clinical practice. While the vast majority are benign and pose no health threat, a small but clinically significant proportion may exhibit dysplastic features or progress to malignant melanoma, a highly aggressive form of skin cancer with substantial morbidity and mortality if not diagnosed and managed promptly. In low- and middle-income countries such as Iraq, access to specialized dermatologic care and advanced diagnostic tools remains limited, placing greater emphasis on clinical acumen and judicious surgical intervention. Ghazi Al-Hariri Hospital for Surgical Specialties, as a tertiary referral center within Baghdad Medical City, serves a diverse patient population and provides a unique setting to evaluate real-world outcomes of mole excision in a resource-conscious environment. This study aims to characterize the clinical, dermoscopic, and histopathological profiles of excised moles, compare diagnostic accuracy between preoperative clinical assessment and final pathology, evaluate surgical techniques and complications, and assess short- to medium-term oncological and aesthetic outcomes following excision. We conducted a prospective, single-center observational study involving 320 consecutive patients who underwent surgical excision of cutaneous moles between January 2022 and December 2023 at Ghazi Al-Hariri Hospital. All lesions were evaluated using standardized clinical criteria (ABCDE rule), handheld dermo copy, and photographic documentation. Excisions were performed under local anesthesia by board-certified plastic surgeons, with margins tailored to clinical suspicion (1–2 mm for benign-appearing lesions; 5–10 mm for atypical or suspicious lesions). Histopathological examination was carried out by two independent dermatopathologists. Patients were followed for 12 months postoperatively to monitor for complications, recurrence, and cosmetic satisfaction. Results of the 320 excised lesions, 278 (86.9%) were confirmed histologically as benign nevi (intradermal, compound, or junctional), while 42 (13.1%) were classified as malignant or premalignant, including 36 dysplastic (atypical) nevi and 6 cases of melanoma (4 in situ, 2 invasive). The face was the most common anatomical site (41.3%), followed by the trunk (30.6%). Clinical diagnosis demonstrated an overall concordance rate of 89.4% with histopathology. Elliptical excision with primary closure was employed in 94.1% of cases. The overall complication rate was 5.6%, primarily consisting of minor infections and hypertrophic scarring. No recurrences were observed among benign lesions at 12 months; one patient with invasive melanoma experienced local recurrence at 10 months and was referred for wide local re-excision and sentinel lymph node biopsy. Surgical excision of cutaneous moles in a specialized surgical center in Baghdad is both safe and effective. The integration of clinical evaluation, dermo copy, and histopathological confirmation enables accurate diagnosis and appropriate management. Early identification and complete excision of malignant or atypical lesions are critical to preventing disease progression. These findings support the establishment of standardized mole assessment and excision protocols across Iraqi healthcare institutions and highlight the need for enhanced public and professional education on skin cancer awareness.
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