Skin Cancer Surgery

What is Skin Cancer Surgery?

Skin cancer surgery is a medical procedure to remove cancerous growths or lesions from the skin. It is a common and effective treatment for various types of skin cancer. It treats skin cancers such as basal cell carcinoma, squamous cell carcinoma, and melanoma. The goal is to completely remove the cancer while preserving as much healthy skin as possible.

Who is Suitable for Skin Cancer Surgery?

Skin cancer surgery is typically recommended for individuals diagnosed with skin cancer. The suitability of surgery depends on several factors:

Type of Skin Cancer: Basal and squamous cell carcinomas are often treated with various surgical methods, while melanoma may require more extensive procedures.
Size and Location: Smaller cancers are often easier to remove, while those in sensitive areas like the face or near vital structures may require specialised techniques like Mohs surgery.
Health Status: Most people can undergo skin cancer surgery, but some with underlying health conditions may require careful assessment and planning.
Staging of the Cancer: If the skin cancer has advanced and spread to nearby lymph nodes or other body areas, additional treatments like radiation or chemotherapy may be needed in conjunction with surgery.
Patient's Preferences: Some individuals prefer less invasive procedures, while others prioritise complete cancer removal.

Benefits of Skin Cancer Surgery

Skin cancer surgery offers several benefits and is an important treatment option for many individuals. Here are the key advantages:

Effective Cancer Removal: Skin cancer surgery is highly effective in removing cancerous growths. It is highly likely to completely remove cancer cells, reducing the risk of cancer recurrence in the treated area.
Preservation of Healthy Tissue: Surgeons aim to preserve as much healthy skin as possible while removing cancerous tissue. This helps maintain the function and appearance of the treated area.
Quick Treatment: Skin cancer surgery is often performed as an outpatient procedure, so you can usually go home on the same day. This minimises disruption to your daily life.
Precise Diagnosis: Procedures like Mohs surgery offer precise microscopic examination of tissue layers, ensuring all cancer cells are removed while sparing healthy skin. This is especially valuable for cancers on the face and other sensitive areas.
Minimal Scarring: With skilful surgical techniques, scarring can be minimised, and in many cases, it becomes less noticeable over time.
High Success Rates: Skin cancer surgery has a high success rate, especially when performed in the early stages of cancer. It can lead to a complete cure and long-term survival for many patients.
Customised Approach: Different types of skin cancer surgeries are available, allowing doctors to tailor the treatment to the specific needs of each patient and their type of skin cancer.

Types of Skin Cancer

Basal Cell Carcinoma (BCC): The most common form of skin cancer, BCC grows slowly and is usually confined to the skin's surface. It is highly treatable and rarely spreads to other parts of the body.
Squamous Cell Carcinoma (SCC): This type of skin cancer is more likely than BCC to invade fatty tissues beneath the skin or spread to distant parts of the body, though this is still relatively uncommon.
Melanoma: The most dangerous form of skin cancer, melanoma can develop in a mole or appear on previously normal skin. It can spread rapidly to other organs, which makes early detection and treatment critical.

Types of Skin Cancer Surgery

Various types of skin cancer surgery are suited for different situations.

Excisional Surgery: This involves removing the cancerous growth and a margin of healthy tissue. It's a standard method for many skin cancers.
Mohs Surgery: Mohs surgery is a highly precise technique that involves removing the cancer in stages and examining each layer under a microscope until no cancer cells are detected. It's often used for complex or sensitive areas.
Cryosurgery: Liquid nitrogen is used to freeze and destroy cancerous cells. It's typically used for superficial skin cancers.
Electrodesiccation and Curettage: This procedure involves scraping off the cancerous tissue and then using an electric needle to destroy any remaining cancer cells. It's suitable for certain types of skin cancers.
Laser Surgery: Laser beams vaporise or remove skin cancer cells. It's often used for superficial or precancerous lesions.
Wide Local Excision: This surgery removes a large area of skin around the tumour to ensure complete removal. It's used for larger or more aggressive skin cancers.

Surgical Techniques for BCC and SCC

If detected early, BCC and SCC are highly treatable through various surgical techniques, such as direct excision, flap surgery, and skin grafting.

BCC and SCC Excision

The standard procedure for excising BCC and SCC involves removing the cancerous lesion along with a margin of healthy tissue around it. This margin is taken to remove all cancerous cells, reducing the recurrence risk. The margin size typically depends on the cancer's size, type, and location.

The primary benefit of excision is its effectiveness in completely removing the cancer. It is a relatively straightforward procedure and, in many cases, can be performed under local anaesthesia on an outpatient basis.

Recovery times can vary, but patients generally experience minimal downtime. Stitches are usually removed within one to two weeks, and patients are advised to limit sun exposure and possibly wear protective clothing.

Flap Surgery

Flap surgery is used when a straightforward closure of the excision site is not feasible. It is typically used in areas with little excess skin or where preserving aesthetic appearance is crucial, such as on the face. In flap surgery, healthy, adjacent tissue is partially cut away and then rotated or shifted to cover the wound.

This technique allows for a more natural-looking reconstruction and better functional outcomes, especially in highly visible areas. It uses tissue that matches the colour and texture of the surrounding area, providing cosmetically pleasing results.

Recovery from flap surgery can be longer than simple excision. Swelling and bruising are common but generally subside within weeks. The risk of complications like flap necrosis, though low, exists and necessitates careful postoperative care.

Skin Graft

A skin graft involves taking a piece of healthy skin from one area of the body (donor site) and transplanting it to the area where skin cancer has been removed. There are two main types of skin grafts: split-thickness (involving only a few layers of skin) and full-thickness (involving the entire skin depth).

Skin grafts are especially useful for covering large surgical wounds or areas where flap surgery isn't viable. They are crucial in managing large areas of skin removal and can be lifesaving in extensive cases of skin cancer.

The healing process for a skin graft can be intensive. Both the donor and recipient sites require care. The graft needs to establish a new blood supply from the wound bed, which can take a week or more. Patients need to avoid activity that may stretch or injure the graft site.

Preparation for Skin Cancer Surgery

Before undergoing skin cancer surgery, there are several important steps to take to ensure a successful and safe procedure:

Schedule a consultation with a dermatologist or surgeon specialising in skin cancer. They will evaluate your condition, discuss treatment options, and determine if surgery is best.
Provide a thorough medical history, including any underlying health conditions and medications you currently take. Certain medications may need to be adjusted or temporarily stopped before surgery.
The doctor will thoroughly examine the skin cancer's size, location, and type. They may take photographs or make markings to guide the surgical procedure.
Follow any preoperative instructions provided by your doctor. This may include fasting before surgery, avoiding certain medications or supplements, and proper wound care if the skin cancer has broken open or is bleeding.
Discuss the type of anaesthesia that will be used during the procedure. Depending on the surgery and patient's preferences, options include local anaesthesia (numbing only the surgical area), regional anaesthesia (numbing a larger area), or general anaesthesia (putting you to sleep).
You can ask questions or express concerns about the surgery, recovery, and potential outcomes. Understanding the procedure and having realistic expectations is crucial.

Skin Cancer Surgery Procedure

Preparation: The surgical area is cleaned and sterilised before the surgery begins. If you're receiving local or regional anaesthesia, it will be administered to numb the area. If general anaesthesia is used, you'll be asleep and unaware during the surgery.
Surgery: The surgeon performs the chosen surgical procedure, which may involve excision, Mohs surgery, cryosurgery, or another technique. The goal is to remove the cancerous tissue while preserving as much healthy skin as possible.
Tissue Examination (for Some Procedures): In Mohs surgery, removed tissue layers are examined under a microscope in real-time to ensure all cancer cells are removed. This process is repeated until the margins are clear of cancer.
Closure: After the cancer is removed, the surgeon may close the wound using stitches, sutures, or skin grafts, depending on the size and location of the surgical site.
Dressing and Bandaging: The surgical site is covered with a sterile dressing or bandage to protect it as it heals.

What to Expect After a Skin Cancer Surgery?

If you received local or regional anaesthesia, you may be able to go home shortly after the procedure. If general anaesthesia is used, you'll wake up in a recovery area before discharge.

Skin Cancer Surgery Recovery Plan

Recovery after skin cancer surgery is an essential part of the treatment process. Here's a recovery plan to help you navigate the postoperative period:

Follow Medical Advice: Adhere to your doctor's post-operative instructions diligently. This includes wound care, medication, and any activity restrictions.
Wound Care: Keep the surgical site clean and dry as directed by your doctor. You may need to change dressings regularly and apply prescribed ointments or creams.
Pain Management: Take prescribed pain medication as directed to manage any discomfort. Over-the-counter pain relievers may also be recommended.
Activity Restrictions: Follow your surgeon's advice regarding physical activity. You may need to avoid strenuous exercise and heavy lifting for a certain period.
Sun Protection: Protect the surgical site from the sun's harmful UV rays. Use sunscreen with at least SPF 30 and wear protective clothing, including wide-brimmed hats and sunglasses.
Scar Care: Once the wound has healed, discuss scar management with your doctor. Various options, such as silicone gel sheets, can minimise the appearance of scars.
Follow-up appointments: Attend all scheduled follow-up appointments with your doctor. These visits are crucial for monitoring your healing progress and addressing any concerns.
Emotional Support: Coping with a cancer diagnosis and surgery can be emotionally challenging. Seek support from friends, family, or a mental health professional if needed.

Skin Cancer Surgery Prognosis

In many cases, surgery can lead to a favourable outcome, such as:

Complete Cure: When performed early, skin cancer surgery often results in a complete cure with no further cancer recurrence.
Low Recurrence Risk: When the cancer is completely removed, the risk of recurrence in the same area is typically low.
Improved Survival: For advanced cases, surgery may be part of a comprehensive treatment plan that includes other therapies like radiation or chemotherapy, potentially improving survival rates.

Skin Cancer Surgery Risks

While skin cancer surgery is generally safe and effective, there are potential risks and complications, which can include:

Infection
Bleeding
Scarring
Nerve Damage
Recurrence
Anaesthesia Risks
Cosmetic Concerns

What if Skin Cancer Surgery is Delayed?

Ideally, skin cancer surgery should be performed as soon as possible after diagnosis to prevent cancer from spreading or becoming more difficult to treat.

It's important to work closely with your healthcare team to navigate any delays in surgery and ensure that you receive the best possible care and treatment when the procedure occurs. Early detection and timely treatment remain critical factors in achieving the best outcomes for skin cancer patients.