Surgery for non-melanoma skin cancer

Surgery is usually used to treat non-melanoma skin cancer. The type of surgery you have depends mainly on the size of the cancer, where it is located and the risk group. When planning surgery, your healthcare team will also consider other factors, such as how the surgery will affect how you look.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the cancer
• repair or rebuild the area where the cancer was removed
• remove lymph nodes
• reduce pain and relieve any symptoms (called palliative surgery)

The following types of surgery are used to treat non-melanoma skin cancer. You may also have other treatments before or after surgery.

Surgical excision removes the cancer along with some normal tissue around it (called the surgical margin). It is a standard and common treatment for many non-melanoma skin cancers, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Surgical excision is also called wide local excision.

Doctors use surgical excision to treat BCC and SCC in all risk groups. A larger surgical margin is usually needed for high-risk cancers. Surgical excision is also used to treat non-melanoma skin cancer that comes back (recurs).

For a surgical excision, a local anesthetic is used to freeze or numb the area. The doctor uses a surgical knife (scalpel) to cut out the cancer from the skin. The area is closed using stitches. The tissue removed is sent to a lab to make sure there are no cancer cells in the surgical margin and that all the cancer has been removed.

Mohs surgery removes the cancer in layers, little by little, until no cancer remains. It is done when doctors want to save as much normal tissue as possible (called tissue sparing) to make sure the skin looks good and to keep the area functioning normally.

Mohs surgery is mainly done for high-risk and recurrent cancers. It is often used for non-melanoma skin cancers on the face, ears, hands and feet.

Find out more about Mohs surgery.

Curettage and electrodesiccation uses a sharp tool to scrape away cancer. Then an electrical current destroys any remaining cancer cells. It is usually used for small, low-risk cancers that are only on the surface of the skin, including SCC in situ. It is also often used for tumours on the neck, trunk of the body, arms or legs.

A local anesthetic is used to freeze the area. A doctor first removes the cancer by scraping it with a tool called a curette. Then the doctor uses a special needle, or electrode, to supply an electrical current directly to the area. The electrical current creates heat, which destroys any remaining cancer cells and helps control bleeding. Curettage and electrodesiccation is usually done 1–3 times during one appointment.

Cryosurgery uses extreme cold to freeze and destroy tissue. Because it treats tumours on the surface of the body, it doesn’t usually require any cuts into the skin like traditional surgeries.

Cryosurgery is mainly used to treat low-risk cancers. It is often used for BCC on the trunk, arms or legs. It is also used for small SCC tumours that are only on the surface of the skin and have clear and smooth borders. Cryosurgery may be used along with curettage.

Find out more about cryosurgery.

Reconstructive surgery is done to help improve how the skin looks after surgery to remove the tumour. Sometimes the doctor has to remove a large area of skin to make sure all of the cancer is gone. You may need reconstructive surgery to fix the area and make it look better.

A skin graft is a piece of skin taken from another part of your body (called the donor site) and placed over the area where the cancer was removed. It is usually done by a plastic surgeon at the same time as the surgery to remove the cancer.

The surgery is done using a local anesthetic (freezing) or general anesthetic (you will be unconscious). The surgeon removes skin from the donor site, such as the inner thigh or buttock. The skin graft is placed over the area where the cancer was removed and will be stitched in place. Both the skin graft and donor site are covered by a bandage and sometimes you are given stitches or staples. The skin graft usually takes 1–2 weeks to heal. Your healthcare team will tell you how to protect and care for the skin graft while it heals.

A skin flap is a thick piece of tissue with its own blood supply. Like a skin graft, a skin flap covers the area where the cancer was removed. A skin flap can be used to repair large wounds on the face.

The surgeon takes the skin flap, which includes skin, fat and sometimes muscle, from an area close to where the cancer was removed. The skin flap often remains partly attached to its original location and blood vessels are still connected. In some cases, the skin flap is completely removed (called a free flap) and the blood vessels of the skin flap need to be connected to vessels at the new site. The skin flap is positioned over the wound and stitched in place.

A lymph node dissection is surgery to remove several lymph nodes from the body. It is not usually needed but may be used for non-melanoma skin cancer that has spread to lymph nodes. Imaging tests or a physical exam will be done to see which lymph nodes need to be removed. The cancer usually spreads to lymph nodes closest to where the non-melanoma skin cancer started.

A lymph node dissection is done using a general anesthetic in a hospital operating room. The surgeon makes a cut to remove lymph nodes. Other nearby tissue may also be removed.

Find out more about lymph node dissection.

Side effects can happen with any type of treatment for non-melanoma skin cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

Side effects can develop any time during, immediately after or a few days or weeks after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery done and where the cancer is. Surgery for non-melanoma skin cancer may cause these side effects:

• pain, which is often managed with pain medicines
• scarring
• bruising
• changes to skin colour
• wound infection
• numbness
• poor healing
• lymphedema( after a lymph node dissection)

Tell your healthcare team if you have these side effects or others you think might be from surgery, or if the area is not healing well. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.