Surgery for Skin Cancer
Surgery is a common way to address skin cancer, and in some cases, it may be the only treatment needed. Johns Hopkins dermatologic surgeon, Jeffrey Scott, M.D., M.H.S., reviews the surgical approaches for treating skin tumors and what you can expect if your doctor recommends surgery for skin cancer.
What You Need to Know
- Surgery is a common treatment for skin cancer.
- Surgical options for skin cancer vary according to the location, type and size of the cancerous tissue, as well as the stage of the disease.
- Surgery for smaller, less complicated skin tumors can often be performed using local numbing medication.
- Larger or more complicated tumors may require a more comprehensive operation, followed by procedures to restore form and function to the affected area.
Skin Cancer Surgery Options
Cryosurgery is the process of spraying liquid nitrogen onto the skin to freeze and destroy tissue. This technique can be used on malignant and benign skin lesions. Over the course of approximately 14 days, the tissue forms a scab and falls off, taking cancerous cells with it. The procedure is typically used in cases of pre-cancerous lesions or skin cancer that is isolated to a small area.
Cryosurgery is less invasive than other surgical options and therefore results in a shorter recovery time as well as minimal pain and bleeding. Since the cancer is treated at the surface level, microscopic cancer spread may not be detected. However, additional cancer treatments can be used in conjunction with this treatment option.
Curettage and Electrosurgery
Curettage is the process of scraping away cancerous skin tissue.
Electrosurgery (burning of tissue with an electric current) is used after curettage to control bleeding and to destroy remaining cancer cells. The procedure is considered to have a high success rate, particularly for small, well-defined skin tumors on the body.
Invented by Frederick Mohs, M.D., this technique is used to treat many skin cancers, including those on the head and neck and other sensitive areas of the body. The procedure is unique because microscopic examination of the cancerous tissue happens during, rather than after, surgery.
The process takes more time than other surgical options because the surgeon removes one layer of skin at a time and examines each one under a microscope until the margins of the affected area are cancer free. Since its development, Mohs surgery has been refined into the most precise and advanced treatment for skin cancer, with success rates up to 99%.
Wide Local Excision
Wide local excision involves removing the cancerous tissue and a margin of surrounding healthy tissue. This technique is used to treat melanoma as well as basal and squamous cell carcinomas.
Skin Grafting and Skin Flaps
If a large portion of cancerous skin is removed during surgery, the surgeon may use a skin flap or skin graft to repair the area. Skin is taken from another part of the body, such as the thigh or groin.
With skin flaps, often the surgeon will try to reconstruct the surgical opening with tissue that is next to the missing skin, transferring tissue of similar color and texture. As a first step, the doctor may place an expander under the skin where the flap will be, which can help additional skin grow for several weeks so there is more to work with when the opening left by the surgery is repaired.
An advantage of skin flaps is that retrieved tissue comes with its own blood supply. Flaps may be used when the area that is missing skin does not have a good supply of blood due to the location or damage to blood vessels. In the head and neck, adjacent tissue flaps can improve the cosmetic appearance. In some cases, additional cosmetic procedures may be recommended.
Lymph Node Removal
Before skin cancer surgery, your doctor will examine the lymph nodes near the cancerous skin for warning signs of metastasis, which is the spread of cancer from one part of the body to another. CT scans, MRI or ultrasound may also be used.
If the doctor finds cancer cells in your lymph nodes, you may require additional surgery to remove them. The lymph nodes act as filters that can catch tumor cells. Removal of lymph nodes (lymphadenectomy) is typically performed by a surgical oncologist, a head and neck surgeon, or a plastic surgeon who specializes in surgical management of cancers.
Lymph node removal can result in the following side effects:
- Lymphedema (swelling of the limb close to the lymph node
- Infection, which is usually treated with antibiotics
- Seroma (fluid buildup at the site of the surgery when removing the lymph nodes), which requires your body to find a new path to filter lymphatic fluid
- Numbness or tingling in the area of the surgery
Skin Cancer Surgery Risk Factors
Patients who have surgery for skin cancer may experience some of the following side effects:
- Wound infection
Avoiding Wound Infection
Infection can occur within the first 30 days after surgery. Signs of infection may include increasing redness or heat, swelling, pain and tenderness, and discoloration of the surrounding tissue. To help avoid infection, the doctor may prescribe antibiotics. You can also take additional measures to reduce the likelihood of infection, including:
- Not removing the bandage for the first 24 to 48 hours after surgery
- Keeping the surrounding area clean
- Showering and washing the area with a liquid antibacterial soap (when cleared by your physician to do so). Do not bathe, swim, or immerse the wound in water until the sutures are gone and your physician clears you to do so.
Dry skin around the wound can delay healing. A thin film of any petroleum-based ointment helps keep the wound moist and avoids scabbing and scarring.
What the Experts Do Summer Skin Safety
Using a broad-spectrum, water resistant sunscreen and wearing protective clothing can shield your skin from harmful ultraviolet (UV) rays.
Learn more of the top tips for protecting your skin, and the latest advancements in skin cancer research.
Recovery from Skin Cancer Surgery
After skin cancer surgery, you may need additional treatment to prevent recurrence of cancer. These postsurgical treatments, often called adjuvant therapy, could include further surgery, chemotherapy, radiation or targeted therapy.