Surgery for skin cancer

For skin cancers that have not spread, surgery may be performed to remove the entire tumor, and no other treatment may be needed. More aggressive skin cancers such as melanoma may require more extensive surgeries. If nearby lymph nodes are enlarged and the doctor suspects cancer cells may have spread, he or she may want to remove the lymph nodes. Common surgical procedures include:

Mohs surgery

Developed in the 1930s by Dr. Frederick Mohs, this technique is designed to remove skin cancer tumors while preserving as much healthy tissue as possible. In this procedure, cancerous cells are removed from the skin layer by layer until the removed layers show no sign of cancer cells. Mohs surgery is most often used on more visible areas, such as the head and neck or hands, to limit scarring. It may also be used on recurrent skin cancers. This surgery may require a local anesthesia and may leave a scar.

Excision

The surgeon performs an excision with a scalpel or sharp razor, cutting or shaving a growth off the skin. The patient may receive a local anesthesia to numb the affected area. Excisions may leave a scar.

Surgeons may perform one of several types of excisions:

A simple excision is created with a scalpel used to remove the skin growth and a small perimeter of surrounding tissue.

A shave excision is a procedure in which a growth is shaved or peeled off the surface of the skin with a sharp razor-like tool.

A wide excision is typically used on melanomas and Merkel cell carcinomas. In a wide excision, the skin tumor and a wider perimeter of healthy tissue is removed. A wide excision may also extend more deeply into the skin than a simple excision.

Reconstructive surgery

Skin cancer surgeries may result in scarring or disfigurement, especially in cases when a wide excision or other extensive surgery is necessary to remove a skin cancer, or when the surgery is performed on the face, head, neck or hands. Consult your doctor about your reconstructive surgery options.

Curettage and electrodessication

In this procedure, a skin lesion is removed with a curette, a long, thin surgical tool with a small, sharp hoop or scoop on the end for scraping. After the lesion is scraped, the area is treated with an electric current through a needle-like electrode designed to kill remaining cancer cells and reduce bleeding. This is called electrodessication. This process of scraping and electrodessication may be repeated several times. It may require a local anesthetic and may leave a scar.

Cryosurgery

Also known as cryotherapy, this technique uses liquid nitrogen to freeze and destroy the cancer cells. The technique may be repeated several times. The treated area may swell and blister and may be scarred after the wound heals. This is usually only used for small skin cancers or pre-cancerous lesions.

Laser surgery

This technique uses a laser beam, an intense, narrow beam of light, to destroy cancer cells. Laser surgery may be used to treat very superficial skin cancers.

Lymph node biopsy and removal

A lymph node biopsy is frequently performed on melanoma patients. In this procedure, your doctor will remove one or more specific lymph nodes, known as sentinel lymph nodes, which directly receive the lymph fluid draining from the tumor. If no sign of cancer is found in the lymph node or nodes, no additional lymph node surgery is necessary. If melanoma cells are found in one or more sentinel lymph nodes, the remaining lymph nodes in the region may be removed.

Surgery for metastatic skin cancer

Basal cell and squamous cell carcinomas, which comprise more than 95 percent of all skin cancers, usually don't metastasize. But melanoma, which accounts for about 2 percent of all skin cancers, may travel to the brain, bones, liver and lungs. When that occurs, surgery may be performed to remove tumors from those locations. Surgery may need to be combined with other treatments, such as immunotherapy or chemotherapy, to treat metastatic cancer. In some cases, surgery for metastatic melanoma may be required to relieve symptoms of the disease.

Side effects of skin cancer surgery

The side effects of skin cancer surgery often depend on how extensive a procedure was required. Even though surgery for basal cell or squamous cell carcinomas is typically minimally invasive, it may produce some side effects. Skin cancers that require more aggressive surgery may produce more challenging side effects.

Side effects of skin cancer surgery may include:

• Pain
• Scarring or disfigurement
• Swelling or bruising
• Nerve damage or numbness
• Bleeding
• Infection
• Fatigue