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Surgery (cutting out the cancer) is the most effective way of treating all skin cancers. If treated early, and fully cut out, more than 90% of patients with skin cancer can be cured by surgery alone.
The types of surgery you might have are:
Surgical Excision or Curettage and Cautery
Both are straightforward, standard operations, performed under local anaesthetic. You will be given an injection to numb only the area of operation. The cancer cells are cut out, along with some of the surrounding normal skin. On small wounds, stitches will be removed after a few days. For wounds on thicker skin, such as on the back, they may left in for up to two weeks. With curettage and cautery the wound is heat-sealed after the operation, and it may leave a flat, white scar.
If you had this operation while you were having your tests, and your biopsy results show that the cancer was fully treated and hasn’t spread, you will not need to have another operation.
Click here for more information on biopsies for skin cancer.
Wide local excision
For most patients with melanoma it is standard practice to remove a wider area of skin around the site of the initial biopsy operation to make sure that no cancer cells have been left behind. This is called wide local excision. As with BCC and SCC, this operation will cure most patients.
The need for wide local excision, and the size of the margin of skin removed, is decided mainly by the thickness of the melanoma found on the original biopsy, as well as the part of the body that is affected.
Occasionally, a wide local excision may be the only procedure performed, but in most cases a narrow margin excision will have been performed first. It may seem a bad idea to have two operations rather than one, but there are two reasons. It is better for the patient as it means that wide excisions are not performed for moles that turn out to be harmless. It also gives the surgeon more information about the melanoma thickness and therefore the amount of skin removal that is required and any more tests that may be necessary.
You may have the operation under a local or a general anaesthetic. Afterwards, in most cases, the wound is stitched up directly. You may be able to go home the same day. If a larger area of skin needs to be removed, a skin graft or flap (see below) may be needed. This will be discussed with you beforehand.
Moh’s micrographic surgery
In some cases a special type of surgery, called Moh’s micrographic surgery may be used if simple surgery is not suitable. The obvious tumour is first removed by excision, or sometimes curettage. Then, after you have had a local anaesthetic, layers of skin are taken off around the tumour one layer at a time. Each piece removed is then examined in its entirety under a microscope, to see whether there are still cancer cells present at any point. This is done in order to ensure that all of the tumour is removed and to conserve as much healthy tissue as possible, and so minimise the size of the defect. Repair of the skin may require a skin graft or skin flap.
For basal cell carcinoma Mohs’ surgery is most often used when it has recurred, or spread to a surrounding area, particularly when the cosmetic look is important - on the face, or some areas of the head and neck.
Moh’s surgery is usually done as an outpatient case.
Skin grafts and skin flaps
If surgery leaves a significant wound, or it is in a highly visible place, such as the face, a small skin graft or skin flap (plastic surgery) may be needed to improve the look.
For a graft, a thin layer of healthy skin is taken from another part of the body. To get the best colour match, skin is usually taken from behind the ear for a face graft. For a graft for other areas of the body, skin is taken from somewhere that is usually hidden, such as the inner thigh area. The two areas involved in the graft will look unattractive to begin with. Within a week or two they will have healed and the scars begun to fade.
In some cases, a general anaesthetic is needed when a skin graft is carried out. Surgery can often be done as a day case. Very occasionally patients will need to stay in hospital for 1-2 days while the grafted skin sticks and starts to heal.
For a skin flap, a slightly thicker layer of skin, including blood vessels, is cut from skin next to the wound, and moved to cover it. It is usually all done under local anaesthetic, as part of the same surgical procedure.
Cryotherapy is a treatment used for basal and squamous cell carcinomas. It involves the use of a very cold substance (liquid nitrogen) to remove the tumour by freezing it. It is only suitable if the cancer is very small. You will be treated in an outpatient clinic, and you will be able to go home the same day.
When the liquid nitrogen is sprayed on to the affected area you may feel a painful stinging sensation. Afterwards it may feel like a burn. A day or two later the skin may blister. It may be a blood blister. This may need draining, but the top of the blister should not be broken. It will need to be covered with a dressing until a scab has grown. After about a month, the scab will drop off, and you may have a white scar.
You will have a follow-up visit between 6 weeks and 6 months later to check that the treatment has been effective. In some cases the treatment may need to be repeated.
Preparing for a general anaesthetic
In the few cases that need a general anaesthetic, your fitness for the anaesthetic will be tested, usually by a nurse specialist at a pre-assessment clinic. An appointment will be arranged with you before the planned date for your surgery. You will be asked about your general health, about any breathing or chest problems you have, about any medicines or supplements you are taking, and allergies. A blood sample may be taken. Your pulse and heart-rate may be monitored. You will not be asked to do exercises.
Careful examination of the tumour and surrounding tissue removed during surgery will help your doctors to decide whether to recommend any additional treatment.
Removing the lymph glands
Avery small number of people with squamous cell skin cancer, and some people with melanoma that has spread, may need surgery to remove nearby lymph glands. Lymph glands are arranged in groups around the body, especially at the neck, armpits and groin. Your surgeon will remove the group closest to your tumour. This is called a lymphadenectomy. It is usually only done if there are suspicious bumps or swelling in the lymph glands. This may be done at the time of surgery to the primary cancer or at a later stage if suspicious glands are found during follow-up.
During follow-up, if your doctor feels a swollen lymph gland, a sample of cells may be taken for examination under a microscope. This is usually taken using a needle and syringe and is called a fine needle aspiration cytology test.
Removal of the lymph glands is quite a big operation and you will need a general anaesthetic. You will be admitted to hospital one day before the operation, to allow for preparation. Following the operation you will have tubes fitted to allow fluid to drain from the wound. You will spend several days recovering in hospital afterwards. How long depends on how long the tubes for draining the wound must be left in. You may have some pain, for which you will be given pain-killers.
There are common side-effects when lymph glands are removed. They include swelling due to a build up of lymph fluid, called lymphoedema, stiffness, and sometimes pain in the limb closest to the site of the operation. Your medical team will tell you how the side-effects can be controlled, and refer you to the Lymphoedema Clinic for ongoing help.
Additional treatment for later stage melanoma
If the melanoma has spread to another part of your body, it is called secondary cancer. In some cases surgery may be used to remove small numbers of secondary tumours in places such as the lungs, gut or brain.
We have a list of questions you might like to ask your surgeon, and more general information about surgery.