Overview
Most skin cancers are removed (surgical excision) by a GP or dermatologist. A surgeon will remove the skin cancer if it is bigger or more complex.
If your skin cancer is in an area that is hard to treat, such as near the eye or on the nose, lips or ears, you may have Mohs micrographic surgery. This is where the doctor removes the cancer little by little and checks each section of tissue under a microscope.
Your wound will be closed by stitches. If you have a large skin cancer removed, you may need a skin flap or skin graft.
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What happens during skin cancer surgery?
Surgery to remove the cancer (surgical excision) is the most common treatment for invasive BCC and SCC. Most small skin cancers are removed by a GP or a dermatologist in their consulting rooms. A surgeon may treat more complex cases.
The doctor will use a local anaesthetic to numb the affected area, then cut out the skin cancer and some nearby normal-looking tissue (margin). This margin may be very small or around 1 cm depending on the type of skin cancer and where it is on your body.
A pathologist checks the margin for cancer cells to make sure the cancer has been completely removed. The results usually take about a week. If cancer cells are found at the margin, you may need further surgery, radiation therapy or other treatment options.
Treatment of sunspots and superficial skin cancer
Many of the treatments described are used for sunspots as well as skin cancers. Some sunspots may need treatment if they are causing symptoms or to prevent them becoming cancers.
Skin cancer that affects cells only on the surface of the skin’s top layer is called superficial. Treatment options for superficial BCC and SCC in situ (Bowen’s disease) include curettage and electrodesiccation (also known as cautery), freezing, topical creams and photodynamic therapy.
Surgery is not always used for superficial BCC and SCC in situ. It may be used if the diagnosis is uncertain or if the area of abnormal tissue does not respond to non-surgical treatments.
Mohs micrographic surgery
Mohs micrographic surgery is usually done under local anaesthetic by a Mohs trained dermatologist or Mohs specialist. It is used to treat skin cancers that have poorly defined edges; cancers in areas that are hard to treat, such as near the eye or on the nose, lips and ears; and BCCs that have come back.
This procedure is done in stages. The doctor removes the cancer little by little and checks each section of tissue under a microscope. They keep removing tissue until they see only healthy tissue under the microscope. Mohs surgery aims to reduce the amount of healthy skin that is removed along with the cancer.
Having Mohs surgery depends on where the skin cancer is and how aggressive or advanced it is. This technique costs more than other types of surgery. Special equipment and training are needed, so it’s available only at some hospitals or clinics.
Repairing the wound after surgery
Most people will be able to have the wound closed with stitches. You will have a scar. This should be less noticeable over time. The area around the excision may feel tight and tender for a few days.
If you have a large skin cancer removed, your doctor will explain the most suitable type of reconstruction for your wound. This may be a:
- skin flap – when nearby loose skin and underlying fatty tissue is moved over the wound and stitched
- skin graft – when a thin piece of skin is removed from another part of the body (the donor site) and stitched over the wound. The donor site may be stitched, or it may be dressed and allowed to heal by itself.
Skin flaps and grafts are often done as day surgery in hospital under a local or general anaesthetic, but may be done in a doctor's rooms. The affected area will heal over a few weeks. Whether you have an excision or Mohs surgery, sometimes you may need more complex reconstructive surgery. This can involve more than one reconstruction technique, surgery that is done in stages, and a longer stay in hospital.
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