There are many different types of skin cancer. Common skin cancers include basal cell carcinomas, squamous cell carcinomas and melanomas. Understanding that treating your skin cancer may result in scars or disfigurement can be troubling. We will guide you through treatment options and explain the resulting effect on your health and appearance.
Although no surgery is without scars, we will make every effort to treat your skin cancer without dramatically changing your appearance.
Procedural Steps
Depending on the size, type and location of the lesion, there are many ways to remove skin cancer and reconstruct your appearance if necessary.
Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include local, intravenous sedation and general anesthesia.
Removal
A small or contained lesion may be removed with excision – a simple surgical process to remove the lesion from the skin. Closure is most often performed in conjunction with excision.
Skin cancer can be like an iceberg. What is visible on the skin surface sometimes is only a small portion of the growth.
Beneath the skin, the cancerous cells may cover a much larger region. In these cases, a specialized technique called Mohs surgery may be recommended.
During this procedure, we may order a frozen section. During this step, the cancerous lesion is removed and microscopically examined by a pathologist prior to wound closure to ensure all cancerous cells have been removed.
The goal is to look for a clear margin – an area where the skin cancer has not spread. If clear margins are found, the resulting wound would be reconstructed. If clear margins are not present, we will remove more tissues until the entire region has a clear margin.
Reconstruction
Skin cancer lesion that is particularly large, is being removed with frozen sections or is likely to cause disfigurement may be reconstructed with a local flap. Healthy, adjacent tissue is repositioned over the wound. The suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the obviousness of the resulting scar.
Alternatively, we may choose to treat your wound with a skin graft instead of a local flap. A skin graft is a thin bit of skin removed from one area of the body and relocated to the wound site.
Skin cancer removal recovery
During your skin cancer removal surgery recovery, incision sites may be sore, red, or drain small amounts of fluid following surgery. Healing will continue for many weeks or months as incision lines continue to improve.
It may take a year or more following a given procedure for incision lines to refine and fade to some degree. In some cases, secondary procedures may be required to complete or refine your reconstruction.
Sun exposure to healing wounds may result in irregular pigmentation and scars that can become raised, red, or dark. Sun exposure may increase the risk of the development of skin cancer in another region of your body.
Skin cancer removal risks
You will have to decide if the risks and potential complications of skin cancer removal surgery are acceptable.
The risks include:
- Allergies to tape, suture materials and glues, blood products, topical preparations, or injected agents
- Anesthesia risks
- Excessive bleeding
- Change in skin sensation
- Damage to deeper structures – such as nerves, blood vessels, muscles – can occur and may be temporary or permanent
- Infection
- Poor healing of incisions
- Possibility of revision surgery
- Recurrence of skin cancer
- Systemic spread of skin cancer
These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions prior to surgery.
Skin graft risks
Skin grafts have an added risk that the graft may not “take” and therefore additional surgery may be necessary to close the wound. Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer.