Skin Cancer Surgery - Surgery for skin cancer – Mohs surgery – Surgery for basal and squamous cell skin cancers
What is Skin Cancer Surgery?
Skin cancer surgery is the primary and most effective treatment for removing various types of skin cancer, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.
The primary goal is to completely eradicate the cancerous cells while preserving as much healthy surrounding skin and tissue as possible, ensuring the best cosmetic and functional outcome.
Key Facts About Skin Cancer Surgery
- It is the cornerstone treatment for most non-melanoma and melanoma skin cancers.
- The specific technique chosen depends on the cancer type, size, location, and aggressiveness.
- These are typically outpatient procedures performed under local anaesthesia, allowing you to go home the same day.
Common Types of Skin Cancer Surgery
Excisional Surgery
- Procedure: The surgeon cuts out the entire tumour along with a surrounding margin of healthy-looking skin (the “safety margin”).
- The Specimen is sent to a lab to confirm if the margins are clear of cancer.
- Best for: Small to moderate-sized basal cell carcinomas (BCCs), squamous cell carcinomas (SCCs), and thin melanomas.
Wide Local Excision
- Procedure: Similar to standard excision but with a much larger margin of healthy tissue removed around the tumour.
- Why it’s used: To ensure complete removal of aggressive cancers or melanomas that have a higher risk of spreading microscopically.
- Best for: Melanoma and high-risk squamous cell carcinomas.
Common Issues Leading to Skin Cancer Surgery
Surgery addresses confirmed or highly suspected skin cancers, which often present as:
- A New or Changing Growth: A spot, bump, or patch on the skin that is new, has changed in size, shape, or colour, or refuses to heal and bleeds easily.
- A Suspicious Mole: A mole that meets the ABCDE criteria (Asymmetry, irregular Border, multiple Colours, large Diameter, Evolving).
- A Confirmed Diagnosis: A biopsy has proven the presence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), or melanoma.
- A Recurrent Cancer: A skin cancer that has come back in the same spot after previous treatment.
When is Skin Cancer Surgery Required?
Surgery is the standard of care for most skin cancers. It is typically recommended in these scenarios:
- Biopsy-Confirmed Cancer: A laboratory diagnosis of any type of skin cancer.
- High-Risk Features: A lesion with characteristics that are highly suspicious for melanoma or an aggressive SCC/BCC.
- Cosmetically Sensitive Location: Cancers on the face where tissue preservation is critical for appearance and function.
- Recurrent Cancer: Cancers that have returned after previous treatment like freezing or topical therapy.
- Large or Deep Tumours: Cancers that have grown too large or deep for other treatments to be effective.
- Melanoma: Surgical excision is the primary and essential treatment for all stages of melanoma.
Risks and Complications
While very safe, potential risks include:
- Scarring: All skin surgery results in a scar. The appearance will fade over months to years.
- Infection: Uncommon, but possible. Keep the wound clean and follow care instructions.
- Bleeding or Bruising: Minor bleeding is common; significant bleeding is rare.
- Nerve Damage: Temporary or, rarely, permanent numbness, tingling, or weakness if a small nerve is affected.
- Recurrence: A small chance the cancer can grow back, which is why follow-up is crucial.
- Allergic Reaction: To the local anaesthetic or topical antibiotics.
Recovery and Post-Operative Care
Recovery is generally quick, but proper wound care is essential for healing and minimizing scarring.
- Immediately After: The area will be numb. You will have a bandage and can go home.
- Pain: Most discomfort is mild and manageable with over-the-counter pain relievers like acetaminophen.
- Wound Care:
- Keep the dressing clean and dry for 24-48 hours.
- After that, you can gently clean the area daily with soap and water and apply a recommended ointment (e.g., petroleum jelly).
- Avoid soaking the wound, picking scabs, or exposing it to the sun.
- Activity: Avoid strenuous exercise, heavy lifting, and activities that pull on the incision for 1-2 weeks.
- Sutures: Stitches on the face are usually removed in 5-7 days. Stitches elsewhere on the body may stay in for 7-14 days.
Long-Term Follow-Up Care
- Pathology Results: You will receive a final report confirming the cancer type and, most importantly, if it was completely removed with clear margins.
- Skin Checks: Lifelong regular skin exams are non-negotiable. You will need:
- Full-Body Skin Exams: By a dermatologist every 6-12 months (or more frequently if you have a history of melanoma).
- Self-Exams: Monthly checks of your own skin to spot any new or changing lesions early.
- Sun Protection: Vigilant sun protection (sunscreen, hats, clothing) is critical to prevent new skin cancers from forming.
Frequently Asked Questions (FAQs) About Skin Cancer Surgery
Will the surgery leave a scar?
Yes, all surgeries leave a scar. However, surgeons are experts in minimizing scarring. The scar will be red and raised initially but will fade and flatten significantly over 6-18 months.
Is the surgery painful?
The procedure itself involves local anaesthesia, so you will feel pressure but not sharp pain. Afterward, the area will be sore, but pain is usually easily managed with over-the-counter medication.
What happens if the margins aren't clear?
If the pathology report shows cancer cells at the edge of the removed tissue (positive margins), you will need a second surgery to remove the remaining cancer and achieve clear margins.
How soon can I go back to work?
If you have a sedentary job, you can often return the next day. For jobs involving physical labour or if the surgery site is in a bothersome location, you may need a few days to a week off.
Can I wear makeup after surgery on my face?
Once the wound is fully closed and the stitches are out (usually after about a week), you can typically use makeup to camouflage the redness.
How do I know if I need a skin graft or flap?
For large wounds where the skin can’t be stretched together, your surgeon may perform a skin graft (taking skin from another site) or a local flap (rearranging nearby skin). They will discuss this with you beforehand if it’s a possibility.
What are the signs of a wound infection?
Contact your doctor if you experience: increasing redness, swelling, warmth, pus, fever, or pain that worsens instead of improves a few days after surgery.