Skin cancer surgery at Warwickshire Hospital

What is skin cancer surgery?

Skin cancer surgery removes cancerous cells from your skin, along with a border of normal-looking skin around them, so nothing is left behind. For many people with an early skin cancer, this is the only treatment they need.

What conditions does it treat?

This surgery is used for treating types of skin cancer such as:

• basal cell carcinoma (BCC)
• squamous cell carcinoma (SCC)
• malignant melanoma.

What are the benefits of skin cancer surgery?

Surgery removes the cancer completely for most people, often as the only treatment they will ever need for it. Some techniques, particularly Mohs micrographic surgery, offer very high cure rates.

Are there different types or surgical approaches?

Yes, and which one you are offered depends on the size, depth and location of your cancer:

• excision: cutting out the cancer along with a margin of healthy-looking skin, with that margin later examined under the microscope to make sure nothing has been missed
• Mohs micrographic surgery: a specialised technique that removes the cancer gradually, one thin slice at a time, with each slice checked under the microscope straight away before deciding whether to continue, stopping once a slice comes back completely clear; particularly used for cancers on the face or other sensitive areas, or ones that have come back before
• curettage and electrocautery: scraping away a small cancer with a spoon-shaped instrument, then using heat to seal the wound and destroy any remaining cells
• skin graft or skin flap: used to cover a larger wound, either with skin taken from elsewhere on your body (a graft) or nearby skin moved into place (a flap).

What happens before the operation?

Before your surgery, you can expect:

• a consultation to confirm surgery is right for you and discuss which technique suits your cancer
• an explanation of the risks and benefits, along with any specific instructions to follow beforehand
• a decision on whether you will have a local anaesthetic (awake, with the area numbed) or a general anaesthetic (asleep), based mainly on how big your cancer is and whereabouts it is
• advice to set aside a full day if you are having Mohs surgery, even though many people finish sooner.

What happens during the procedure?

1. The area is numbed with a local anaesthetic, or you are given a general anaesthetic for a larger operation.
2. The surgeon cuts out the cancer together with a margin of healthy-looking skin surrounding it.
3. That tissue is examined under the microscope; with Mohs surgery, this happens there and then, one slice at a time, with more tissue taken away and re-examined from any spot where cancer remains, until a slice comes back clear.
4. If the wound is small, it is closed straight away with stitches.
5. If a larger area of skin has been removed, it may be covered with a skin graft from elsewhere on your body, or a nearby skin flap.
6. A dressing is applied, and you are given instructions for looking after the wound at home.

What does recovery look like?

Most people go home on the day of their surgery, whichever technique they have had; needing a general anaesthetic for a larger operation is the main reason you might stay in hospital overnight instead. Before you leave, you are shown how to care for the wound and dressing, and a district nurse, your GP surgery, or the hospital can change the dressing for you if needed.

Non-dissolvable stitches are usually removed one to two weeks after surgery, sometimes a little later. If you had a skin graft or flap, rest matters more than usual for the first two weeks while that tissue settles in. Numbness near the wound, if you have any, tends to ease off gradually as the weeks and months go by. Your scar will keep changing for some time afterwards, often taking the best part of a year, sometimes longer, to reach how it will finally look.

What are the risks and complications?

As with any operation, there are risks to be aware of:

• bruising and bleeding
• wound infection
• some pain and swelling around the wound in the days after surgery
• numbness or altered sensation near the wound, which usually settles down as the weeks and months pass
• a permanent scar, even where every effort is made to keep it as small and neat as possible.