Surgery to remove the cancer (surgical excision) is the most common treatment for invasive basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Most small skin cancers are removed by a GP or a dermatologist in their consulting rooms. A surgeon may treat more complex cases.
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What happens during surgery?
The doctor will inject a local anaesthetic to numb the affected area, then cut out the skin cancer and some nearby normal-looking tissue (margin). The recommended margin is usually between 2 mm and 10 mm depending on the type and location of the skin cancer.
A pathologist checks the margin for cancer cells to make sure the cancer has been completely removed. The results will be available in about a week. If cancer cells are found at the margin, you may need further surgery or radiation therapy.
For more on this, see our general section on Surgery.
Mohs micrographic surgery
Mohs micrographic surgery is usually done under local anaesthetic by a dermatologist or a Mohs specialist. It is used to treat skin cancers that have begun to spread deep into the skin. It can also be used for cancers in areas that are hard to treat, such as near the eye or on the nose, lips and ears.
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 with the cancer.
Only some skin cancers are suitable for Mohs surgery. 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
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 talk with you about what type of reconstruction is suitable for your wound. There are two main ways to do this:
- skin flap – nearby loose skin and underlying fatty tissue is moved over the wound and stitched
- skin graft – a piece of skin is removed from another part of the body (called the donor site) and stitched over the wound. The donor site may be stitched closed, or it may be dressed and allowed to heal by itself.
Skin flaps and grafts may be performed in the doctor’s office but are sometimes done as day surgery in hospital under a local or general anaesthetic. The affected area will heal over a few weeks.
Whether you have an excision or Mohs surgery, sometimes you may need a more complex reconstructive procedure. This can involve more than one reconstruction technique, surgery that is done in stages, and a longer stay in hospital.
Learn more about the different types of skin cancer.
Podcast: Making Treatment Decisions
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A/Prof Stephen Shumack, Dermatologist, Royal North Shore Hospital and The University of Sydney, NSW; Dr Margaret Chua, Radiation Oncologist, Head of Radiation Oncology, Skin and Melanoma, Peter MacCallum Cancer Centre, VIC; John Clements, Consumer; Aoife Conway, Skin Lead and Radiation Oncology Nurse, GenesisCare, Mater Hospital, NSW; Sandra Donaldson, 13 11 20 Consultant, Cancer Council WA; Kath Lockier, Consumer; Dr Isabel Gonzalez Matheus, Plastic and Reconstructive Surgery, Principal House Officer, Princess Alexandra Hospital, QLD; A/Prof Andrew Miller, Dermatologist, Canberra Hospital, ACT; Dr Helena Rosengren, Chair Research Committee, Skin Cancer College of Australasia, and Medical Director, Skin Repair Skin Cancer Clinic, QLD; Dr Michael Wagels, Staff Specialist Plastic and Reconstructive Surgeon, Princess Alexandra Hospital and Surgical Treatment and Rehabilitation Service, and Senior Lecturer, The University of Queensland, QLD; David Woods, Consumer.
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