Surgery for skin cancer
Surgery is the most common treatment for skin cancer. Different surgical techniques can be used to remove the cancer cells. The type of surgery you have depends on the size of the cancer and where it is. Rarely, surgery is needed to remove the nearby lymph nodes if the cancer has spread.
Most small skin cancers are removed in a minor operation called an excision. It is usually done using a local anaesthetic and you can go home on the same day.
The surgeon or dermatologist will remove (excise) the cancer and some normal-looking skin around it (margin). The normal-looking skin is checked under a microscope to make sure all the cancer has been removed. You will have a dressing over the wound.
A type of surgery called Mohs micrographic surgery may sometimes used. Some people have a type of surgery called curettage and electrocautery to remove small skin cancers.
If the cancer is large or has spread, the surgeon may need to remove a larger area of skin. This is called a wide local excision. You have this done under a general anaesthetic.
Skin graft or skin flap
If you need a larger area of skin removed the surgeon may need to cover the wound with a healthy layer of skin from another part of the body. The is called a skin graft. Less commonly, a very specialised operation called a skin flap surgery is done.
After a skin graft, you can usually go home on the same day. Some people may need a short stay in hospital. It depends on where the graft is and how big it is. You may need to stay in hospital for a few days after skin flap surgery.
This is specialised surgery which is sometimes called a margin-controlled excision. You have this done in a centre that specialises in Mohs surgery. You usually only need a local anaesthetic and can go home on the same day.
During Mohs surgery, the surgeon removes the cancer in thin layers. During surgery they examine this tissue under a microscope. They continue to remove layers until no cancer cells can be seen. This makes sure all the cancer cells are removed but only a very small amount of healthy tissue.
Mohs surgery can be used for skin cancers that:
- have come back in the same place after being removed
- could not be completely removed
- are faster-growing and have started to spread into surrounding area
- are on the face so the surgeon removes as little tissue as possible and reduces scarring
- are larger, for example, bigger than 2cm.
Some people may need a skin graft or skin flap to cover the wound.
This type of surgery 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 gives you a local anaesthetic to numb the area. Once the area is numb, the doctor scrapes away the cancer using an instrument called a curette. They then use an electrically heated loop or needle to stop any bleeding from the wound (cauterise the wound). This also destroys any remaining cancer cells.
Before you go home, your nurse will explain how to take care of the wound and the dressing. If necessary, they can arrange for a district nurse to change your dressing at home. Or they may advise you to go to your GP or come back to hospital to have the dressing changed.
If you have stitches, they are usually removed 5 to 14 days after surgery or once the wound has healed. Sometimes surgeons use dissolvable stitches that do not need to be removed.
If you had a skin graft or skin flap surgery, it's important to try to rest for the first couple of weeks after surgery. You need to allow time for the skin graft or skin flap to heal properly.
If you have a squamous cell carcinoma (SCC) of the skin, that has spread, your surgeon may advise having some nearby lymph nodes removed. Only a small number of people with SCCs will need this. It is not done for basal cell carcinomas (BCC) as these almost never spread to the lymph nodes.
The operation is called a lymph node dissection or a lymphadenectomy. It is done to see if there are any cancer cells in the lymph nodes. If there are cancer cells present, removing the lymph nodes helps to stop them spreading further. This is a large operation and is done under a general anaesthetic.
After surgery, you will have tubes (drains) coming from the wound to allow fluid to drain away. These will be removed a few days after surgery.
Below is a sample of the sources used in our skin cancer information. If you would like more information about the sources we use, please contact us at email@example.com
National Institute for Health and Care Excellence (NICE) NICE pathways: Skin Cancer Treatment overview. (updated 2020)
Institute for Health and Care Excellence (NICE). Sunlight exposure: risks and benefits. NICE guideline [NG34] Published:2016.
British Journal of Dermatology. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma. 2020.
National Institute for Health and Care Excellence (NICE) Cemiplimab for treating metastatic or locally advanced cutaneous squamous cell carcinoma [TA592] Published: 07 August 2019.
BMJ Best Practice. Overview of Skin Cancer. (updated 2019)
British Association of Dermatologists. Service Guidance and Standards for Mohs Micrographic Surgery (MMS). 2020.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Samra Turajlic, Consultant Medical Oncologist.
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