Surgery is the most common treatment for skin cancer. How it is done depends mostly on the size of the cancer and where it is.
If you have a small cancer, the doctor can usually remove (excise) it under local anaesthetic. Or they may use a technique to destroy the cells known as curettage and electrocautery.
A larger cancer is more likely to be removed 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.
Most small skin cancers are removed by simple surgery. The surgeon or dermatologist will remove the cancer and 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 to 14 days after your operation. Sometimes surgeons use dissolvable stitches that do not need to be removed.
Most operations are done under local anaesthetic and you can go home on 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.
This is 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:
- skin 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 surgeon removes the cancer in thin layers. The tissue that has been removed is looked at under a microscope during the surgery. The surgeon continues to remove more layers until no cancer cells are seen in the tissue. This technique makes sure that all the cancer cells are removed and only a very small amount of healthy tissue is removed.
Mohs surgery is often done under local anaesthetic. You are usually allowed to go home the same day.
If you are having a large cancer removed, you may also need to have a skin graft or skin flap to cover the wound.
Curettage and electrocautery
Occasionally, people have treatment using curettage and electrocautery. This involves scraping away the cancer and using heat or electricity to stop any bleeding. It is usually only used for skin cancers that are small.
First, the doctor or nurse will give you a local anaesthetic. Once the area is numb, the doctor will scrape away the cancer using an instrument called a curette. They then use an electrically heated loop or needle to stop any bleeding (cauterise 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 they have pale skin.