Skin cancer removal: There are several different types of surgery for skin cancer, and the method your doctor uses depends on the size and location of the growth and other factors.
Here are some of the different types of surgery:
Excisional skin surgery is a common treatment for this cancer. After numbing the area, the surgeon removes the growth with a scalpel and removes the skin around the growth.
This skin is called a margin, and it is examined under a microscope to make sure all the cancer cells have been removed, and its size depends on the size of the growth.
Mohs surgery (micrographic surgery) is usually used for skin cancer (skin tumors). The growth is numbed. The surgeon removes thin layers of the growth, and each layer is immediately examined under a microscope.
The surgeon continues to scrape away layers until no cancer cells are visible in the layers. In this procedure, the surgeon removes the entire cancer and only a small amount of healthy tissue.
Electrocautery and curettage is usually used to remove small basal cell skin cancers. The cancer is removed with a sharp, spoon-shaped instrument called a curette, and then an electric current is sent to the area being treated to control bleeding and kill any remaining cancer cells. Electrocautery and curettage is usually a quick and simple procedure.
Cryosurgery is usually used to treat early-stage cancer or very thin skin cancers in people who cannot tolerate other types of surgery.
In this procedure, the doctor applies liquid nitrogen directly to the growth. This treatment sometimes causes swelling and nerve damage, which can cause loss of sensation in the affected area.
More information is available in the Cancer Research, Education and Prevention Institute’s scientific, medical and educational database, “Cryosurgery in Cancer Treatment: Questions and Answers.”
Laser surgery uses a narrow beam of light to remove cancer cells; this method is usually used for growths that have developed only in the lower layers of the skin.
Grafts are sometimes used to connect and close the skin gap caused by surgery; the surgeon first numbs a piece of healthy skin and takes it from another part of the body, such as the upper thigh; this piece of skin is used to cover the area where the skin cancer was removed. If you have a skin graft, you will need to take special care of it and protect it so that it heals.
Recovery time after surgery varies from person to person. You may experience some pain and discomfort for a few days. This can usually be controlled with medication. If more pain relief is needed, your doctor can schedule it before surgery.
What happens during skin cancer surgery?
Depending on the size, type, and location of the lesion, there are several methods for removing skin cancer and restoring appearance.
First stage – Anesthesia
You will be given medication to make you comfortable during surgery. Options include local anesthesia, intravenous sedation, and general anesthesia. Your doctor will recommend the best option for you.
Second stage – Removing the lesion
A small or localized lesion can be removed with an excision (a simple surgical procedure to remove a lesion from the surface of the skin). In most cases, the area is repaired with an excision.
Skin cancer can be like an iceberg. Sometimes what is visible on the surface of the skin is only a small part of the mass. Beneath the surface of the skin, cancer cells cover a larger area and have no clear boundaries. In these cases, a special procedure called Mohs’ surgery (MOHS) may be recommended.
Your plastic surgeon may request a frozen section (pathology). In this procedure, the cancerous lesion is removed and examined microscopically by a pathologist before the wound is closed to ensure that all cancer cells have been removed. The goal is to achieve a healthy margin (an area where the skin cancer has not spread). If a healthy margin is achieved, the resulting scar can be reconstructed. If a healthy margin is not achieved, your plastic surgeon will remove enough tissue to cover the entire area with a healthy margin.
Step 3 – Reconstruction
A large lesion or one that was removed with frozen sections can be reconstructed with a local flap (healthy tissue). A flap may also be used in cases where excision results in a disfiguring appearance. A local flap brings healthy tissue adjacent to the scar over the scar. If possible, suture lines are placed in natural grooves and indentations of the face to make the resulting scar less noticeable.
A skin graft (healthy skin taken from another area of the body and placed over the wound) may also be used.
Step 4 – Reviewing the Results
After the skin cancer is removed and initial reconstruction is complete, a dressing or bandage will be placed over the incisions.
The decision to have skin cancer surgery is a very personal one. Your doctor will explain all the possible risks. Your plastic surgeon or other medical staff will explain the risks of surgery in detail. You will be asked to sign consent forms to indicate that you understand the type of surgery, other options, and the most likely risks and complications.
Possible risks include:
Bleeding (hematoma)
Infection
Problems with incision healing
Risks of anesthesia
Poor healing site
Uncertainty of frozen section examination (pathology)
Recurrence of skin cancer
General spread of skin cancer
Change in skin sensation
Irregular skin texture
Change in skin color, swelling
Sensitivity to tape, sutures, blood products, topical or injected medications
Damage to deep structures such as nerves, blood vessels, muscles, veins, which may be temporary or permanent.
Pain that may be long-lasting
Possibility of needing re-surgery
It is very important to ask your plastic surgeon questions about your procedure. It is normal to have some anxiety (whether from excitement about the anticipation of your new appearance, or from stress before the procedure). Don’t be shy about sharing these feelings with your plastic surgeon.
Other important considerations
Skin grafts carry a risk of “not taking,” which may lead to another surgery to close the wound.
Take care of yourself
Once you have been diagnosed with skin cancer, you are at a higher risk than most people for developing another skin cancer. In addition, skin cancer can come back. So it’s important to ask your doctor about the symptoms of skin cancer, examine yourself regularly for suspicious lesions, and attend an annual skin cancer screening.
Take care
Following your doctor’s instructions is key to the success of your surgery. It’s important that the surgical incisions are not subjected to excessive pressure, friction, or movement during the healing period. Your doctor will give you special instructions on how to care for yourself.
After skin cancer surgery, the incisions may be painful, red, or have discharge.
It is important to follow all wound care instructions, such as cleaning and applying topical medications, exactly as directed.
You can resume light activities on the day of your skin tumor surgery.
Be sure to keep the incisions clean and well-protected from injury.
Limit activities that put pressure on the wound or stitches.
As the incision lines heal, healing may take weeks or months. It may take a year or more after each procedure for the incision lines to fade somewhat. In some cases, a second surgery may be needed to complete or correct the reconstruction.
Use sun protection every day of your life, and quit smoking to ensure your wound heals and stays healthy. Sun exposure to healing wounds may cause uneven coloration, raised, red, or dark scars. Sun exposure may cause skin cancer to come back, or cause skin cancer to develop in other areas of your body.
