Surgically removing cancerous and other skin lesions using specialized techniques to preserve your health and your appearance.
Surgery is the most common treatment for skin cancer. The type of surgery you will have depends on the size and position of the cancer.
Skin cancer, much like any form of cancer, may require surgery to remove the cancerous growth. Your plastic surgeon can surgically remove cancerous and other skin lesions using specialized techniques to preserve your health and your appearance.
Although no surgery is without scars, your plastic surgeon will make every effort to treat your skin cancer without dramatically changing your appearance.
Many small skin cancers are removed by a surgeon or dermatologist using simple surgery. They will remove the lump and some normal-looking skin around the area. Most operations will be done under local anaesthetic and you’ll be able to go home the same day.
Larger cancers are usually removed under general anaesthetic. The area removed will be replaced with a skin graft or skin flap. These are layers of skin taken from another part of the body. Some hospitals use a specialised type of surgery called Mohs micrographic surgery. This is when the tumour is removed piece by piece until all the cancer cells have gone.
Some people have surgery using curettage and electrocautery. This involves scraping the cancer cells away, using heat or electricity to stop the bleeding. If a squamous cell cancer has spread, you may need to have some lymph nodes removed. This can help to prevent the cancer spreading any further.
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include local, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – Removal
A small or contained lesion may be removed with excision – a simple surgical process to remove the lesion from the skin. Closure is most often performed in conjunction with excision.
Skin cancer can be like an iceberg. What is visible on the skin surface sometimes is only a small portion of the growth.
Beneath the skin, the cancerous cells cover a much larger region and there are no defined borders. In these cases, your plastic surgeon may use frozen sections during the removal of your skin cancer to discover and define the borders of the cancerous area. Frozen sections are small parts of the tissue that are removed and immediately sent to the pathologist. These pieces of tissue are then quickly frozen so that he or she can examine them for cancer cells at the time of removal of the cancer. This helps your plastic surgeon to make sure that all of the cancer has been removed.
Alternatively, your plastic surgeon may recommend a specialized technique called Mohs surgery. This procedure may be performed by your plastic surgeon, or you may be referred to a surgeon that specializes in this procedure.
Mohs surgery is a procedure that is performed through the use of multiple specially prepared frozen sections. The goal is to look for a clear margin – an area where the skin cancer has not spread. If clear margins are found, the resulting wound can be reconstructed. If clear margins are not present, the surgeon will remove more tissue until the entire region has a clear margin.
Step 3 – Reconstruction
A skin cancer lesion that is particularly large, is being removed with frozen sections or is likely to cause disfigurement may be reconstructed with a local flap.
Healthy, adjacent tissue is repositioned over the wound. The suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the obviousness of the resulting scar.
Your surgeon may choose to treat your wound with a skin graft instead of a local flap. A skin graft is a thin bit of skin removed from one area of the body and relocated to the wound site.
Step 4 – See the results
After your skin cancer has been removed and any primary reconstruction is completed, a dressing or bandages will be applied to your incisions.
During your skin cancer removal surgery recovery, incision sites may be sore, red or drain small amounts of fluid.
- It is important to follow all wound care instructions such as cleansing and applying topical medications exactly as directed
- You will be able to return to light activity as instructed by your surgeon
- Make certain to keep your incision sites clean and well protected from potential injury
- Try to limit movement that may stress your wound and your sutures
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery?
- When will they be removed?
- Are stitches removed? When?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
- How long will it take before healing is complete?
Healing will continue for many weeks or months as incision lines continue to improve.
It may take a year or more following a given procedure for incision lines to refine and fade to some degree. In some cases, secondary procedures may be required to complete or refine your reconstruction.
Sun exposure to healing wounds may result in irregular pigmentation and scars that can become raised, red or dark. Sun exposure may increase the risk of the development of skin cancer in another region of your body.
You will have to decide if the risks and potential complications of skin cancer removal surgery are acceptable.
You will be asked to sign consent forms to ensure that you fully understand the procedure.
The risks include:
- Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
- Anesthesia risks
- Excessive bleeding
- Change in skin sensation
- Damage to deeper structures – such as nerves, blood vessels and muscles – can occur and may be temporary or permanent
- Poor healing of incisions
- Possibility of revision surgery
- Recurrence of skin cancer
- Systemic spread of skin cancer
These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon.
Skin graft risks
Skin grafts have an added risk that the graft may not “take” and therefore additional surgery may be necessary to close the wound.
Preserve your health
Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer. Skin cancer may reoccur. So, it’s important to discuss the signs of skin cancer with your physician, regularly perform self-examinations for suspicious lesions and schedule an annual skin cancer screening.
Your plastic surgeon can treat your skin cancer by surgically removing cancerous skin and closing the resulting wound. Some forms of skin cancer require additional treatment such as radiation therapy.
Your physician will advise you about any follow-up treatment recommendations.
Reconstruction closes the skin cancer defect, but no reconstruction is perfect. Visible scars will always remain at incision sites. You may also see textural, color or other visible differences of the skin in reconstructed areas.
In some cases, treating your skin cancer can be disfiguring to your appearance.
Although every effort is made to restore your appearance as closely and naturally as possible, the most important factor is that your skin cancer is effectively removed.
Following your physician’s instructions is essential to the success of your surgery. It’s important that the surgical incisions are not subjected to excessive force, swelling, abrasion or motion during the time of healing.
Your doctor will give you specific instructions on how to care for yourself.
Use this checklist as a guide during your skin cancer removal consultation:
- Are you certified by the American Board of Plastic Surgery?
- Were you specially trained in the field of plastic surgery?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
- How many procedures of this type have you performed?
- Am I a good candidate for this procedure?
- What will be expected of me to get the best results?
- Where and how will you perform my procedure?
- What shape, size, surface texturing, incision site and placement site are recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if I am dissatisfied with the outcome of my skin cancer surgery?
- Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?
Basal cell carcinoma
The most common form of skin cancer. Occurs in the epidermis. These growths are often round and pearly or darkly pigmented.
The uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.
The uppermost portion of skin.
A simple surgical process to cut the lesion from the skin.
A surgical procedure in which the cancerous lesion is removed and then frozen before being microscopically examined by a pathologist prior to wound closure. This is done to ensure all cancerous cells have been removed.
Drugs and/or gases used during an operation to relieve pain and alter consciousness.
Sedatives administered by injection into a vein to help you relax.
A surgical procedure used for skin cancer in which healthy, adjacent tissue is repositioned over the wound.
A skin cancer that is most often distinguished by its pigmented blackish or brownish coloration and irregular and ill-defined borders is the most serious form of skin cancer. It occurs in the deepest portion of the epidermis, and for this reason, melanoma is the most likely form of skin cancer to spread quickly in the skin and to other parts of the body.
A surgical procedure that’s used when skin cancer is like an iceberg. Beneath the skin, the cancerous cells cover a much larger region and there are no easily defined borders.
A surgical procedure used for skin cancer. Healthy skin is removed from one area of the body and relocated to the wound site. A suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the appearance of the resulting scar.