Surgery for skin cancer
Surgery is the most common treatment for skin cancer. How it's done depends mostly on the size of the cancer and where it is.
Small cancers can often be removed (excised) under local anaesthetic or by a technique known as curettage and electrocautery.
Larger tumours are more likely to be cut out while you are under a general anaesthetic. The skin is replaced with a skin graft or skin flap, if needed. A type of surgery called Mohs micrographic surgery (or margin-controlled excision) is used in some hospitals in the UK.
Many small skin cancers are removed by simple surgery. The surgeon or dermatologist removes the lump and also some normal-looking skin around it. The normal-looking skin is checked to make sure that the cancer has completely gone. You will have stitches that may need to be removed 5–14 days after your operation. Sometimes surgeons use dissolvable stitches that don’t need to be removed.
Most operations will be done under local anaesthetic and you will go home the same day. The wound will be covered by a dressing. The staff at the hospital will explain how to take care of the area and the dressing. If necessary, hospital staff can arrange for a district nurse to change your dressings at home. Or they may advise you to go to your GP surgery or return to the hospital for help with dressing the wound.
Skin grafts and skin flaps
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If the tumour is large or spreading, a larger area of skin may need to be removed. You may need a skin graft or, less commonly, a skin flap to cover the wound. Skin grafts and flaps are layers of skin taken from another part of the body and placed over the area the skin cancer has been removed from.
A skin graft is a very thin layer of skin. The surgeon (often a plastic surgeon) will take a layer of skin from another part of the body (the donor site). The inner thigh is a common place to take the skin from. It’s then put over the area where the cancer has been removed.
A skin flap is a slightly thicker layer of skin, which is taken from an area very close to the wound where the cancer has been removed. The flap is cut away but left partly connected so it still has a blood supply. It’s moved over the wound and stitched in place. You may also have some stitches around the donor site. This is a specialised type of surgery and you may have to travel to a different hospital to have it.
If you have a skin graft, you can probably go home the same day. If the graft is large or if you have a skin flap, you may have to stay in hospital for up to four days. With a skin graft, you will normally have a dressing over the area to press the graft down. This helps it to create a good blood supply from the blood vessels underneath. A skin graft for the face will usually be taken from behind the ear or the neck area to try to get a good skin colour match. The area where the graft has been placed will look very noticeable to begin with, but will heal in about two weeks. It will then fade and become less obvious.
If the skin graft is taken from the thigh area, it can take about two weeks or more to heal and may be a bit sore afterwards. The area the graft was taken from will also become less noticeable when it has healed.
Mohs micrographic surgery
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This is very specialised surgery, also known as margin-controlled excision, and is only available at a few hospitals in the UK. Your specialist will refer you to one of these centres if they think you might need this technique.
Mohs surgery is particularly useful for:
basal cell cancers that have come back in the same place
when the doctor thinks that the cancer has begun to spread into the surrounding area
skin cancers on the face (to minimise the effects of surgery)
large skin cancers.
During Mohs surgery, the tumour is removed piece by piece. As each piece is removed, it’s examined under a microscope straight away. Skin tissue is gradually removed until there are no signs of any cancer cells. This technique aims to remove as little healthy skin as possible, while making sure that all the cancer has been taken away. The procedure is often done under local anaesthetic and you are usually allowed to go home the same day.
If you’re having a large tumour removed, you may also need to have a skin graft or flap to cover the wound (see above).
Curettage and electrocautery
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Occasionally, people have treatment using curettage and electrocautery. This involves scraping away the cancer and using heat or electricity to stop any bleeding.
First, you will be given a local anaesthetic. When the area is numb, the doctor will scrape away the cancer using a spoon-shaped instrument called a curette. They then use an electrically heated loop or needle to stop any bleeding (cauterising the wound) and destroy any remaining cancer cells.
This treatment usually gives good cosmetic results. A few people may develop some scarring, which may be more noticeable if you have fair skin.
If there’s evidence that a squamous cell cancer has spread, you may need to have some lymph nodes removed. This operation is called a lymphadenectomy and is done to see whether there are any cancer cells in the lymph nodes. If cancer cells are present, removing the lymph nodes can help to prevent further spread. This is a large operation and is done under a general anaesthetic.
Only a very small number of people who have squamous cell carcinoma need this operation. It isn’t done for people with basal cell carcinoma, as this almost never spreads to the lymph nodes.
After a lymphadenectomy, you’ll have tubes (drains) in place to allow fluid to drain from the wound. These will be removed a few days after the operation. Occasionally, this operation may cause swelling of the affected area. This is called lymphoedema and happens when lymph fluid can’t drain properly from the area after the lymph nodes have been removed.