Dermatologists routinely determine by physical examination that almost all moles are "clinically benign", meaning they are very unlikely to be cancerous. They do not recommend removal or consider it "medically necessary." If the patient requests removal anyway, the procedure would be considered "cosmetic".

Dermatologists also typically offer to provide biopsies of removed moles to confirm whether they are cancerous. However, this procedure is relatively expensive and provides almost no value to the patient if the mole has already been determined clinically benign.

For some reason, though, most dermatologists WILL NOT remove any mole, even a clinically benign mole, unless the patient ALSO agrees to pay for a biopsy. This practice appears to increase the cost to the patient of mole removal by 5-10x, while providing almost no value to the patient if the mole is clinically benign.

Any argument that this practice "protects the patient" is bogus. If a mole is in fact cancerous, it is ALWAYS better to remove it than to leave it in place, regardless of its clinical diagnosis. So the risk to the patient's health of leaving a clinically benign mole in place because the patient refuses to pay for a biopsy seems far HIGHER than the risk of removing a clinically benign mole and failing to perform a biopsy on it.

Why do so many dermatologists follow this bizarre practice of insisting on expensive biopsies for moles that they have already competently determined to be clinically benign? This seems like a pretty obvious dermatologist-pathology racket, not patient-centered care.