You can — for skin tags, very small benign moles or cosmetic-only procedures where the appearance is unambiguously benign. For any other mole, lesion or unusual lump, we strongly recommend histology. Skin cancers (basal cell, squamous cell, melanoma) can look identical to benign moles to the naked eye. The histology fee is what stands between "your mole was benign" and "your mole was a melanoma we caught in time." We won't pressure you, but we'll always recommend it for anything but the most obviously benign cases.