What to Know About Surgery for Nonmelanoma Skin Cancer

Surgery is the most common way to treat nonmelanoma skin cancer. Many techniques can be used to remove the cancer. The goal is to completely remove the cancer while trying to limit damage to healthy tissue. This is especially important when the cancer is on the face. The technique your doctor recommends depends on these factors.

  • The size of the tumor

  • The type of cancer

  • The location of the tumor

  • Whether the area of the tumor is visible, such as on your face

  • Whether the tumor has spread

  • Your health status

  • Whether cancer is likely to occur again

  • If the area has been treated before and the cancer has recurred

Your doctor will explain which types of surgery may be best for you. For example, your doctor may suggest the Mohs procedure if the tumor’s location may affect your appearance, such as on your face. Mohs surgery may also be recommended if the tumor has recurred after previous treatment or if it is large. If the tumor is small or on your limbs or trunk, your doctor may recommend simple excision. Laser treatment and dermabrasion are not as widely used because it is not possible to determine that all the cancer cells were removed with these techniques. These treatments also do not produce a specimen for the pathologist to look at. Your doctor will describe what to expect during and after the surgery.

These are the surgeries used to treat nonmelanoma skin cancer.

Mohs Surgery

During a Mohs procedure, you’re given a local anesthetic to numb the area being treated. The cancer is removed from the skin one layer at a time. Each layer is checked under a microscope for cancer. Layers are removed until the doctor doesn’t see any more cancer. The procedure is done at one sitting, but it may take several hours, depending on how many layers need to be removed. Upon completion, the cancer is completely removed and the wound can be repaired. The Mohs technique is a tissue-sparing technique, which means it limits the area that is operated on. Mohs surgery may be a good option when any of these things are true:

  • Your doctor is not sure of the exact depth and shape of the tumor

  • The tumor is very large

  • The tumor is located in a difficult-to-treat place

  • Skin cancer has recurred

  • Cancer is on the face

Curettage and Electrodesiccation

You are given a local anesthetic to numb the area. Your doctor then uses a spoon-shaped instrument called a curette to remove the cancer. After curettage, your doctor passes an electric needle over the surface of the scraped area to destroy any remaining cancer cells. After it heals, a flat, white scar may remain.

Simple Excision

You are given a local anesthetic. Then, your doctor uses a scalpel to remove the tumor from the skin. The doctor may also remove some of the normal skin around the tumor. This is called a "margin." Depending on the size of the incision, stitches or a sterile bandage strip may be used to close the wound. The tissue that was removed is sent to a pathologist for analysis. If the report reveals that not all the cancer was removed, it’s likely you’ll need a further procedure to remove the rest of the cancer.

Shave Excision

This method is used for superficial cancers. You are given a local anesthetic. Then, your doctor uses a small blade to shave off the tumor. The goal is to remove the tumor at its base.

Cryosurgery

Your doctor uses an instrument to freeze the tumor. Freezing destroys the cells. The dead skin then falls off after the area thaws. Pain is minimal, although you may have some swelling. A white scar usually results. This technique is best for very small cancers near the skin’s surface.

Potential side effects from surgery

The length of time it takes to recover from surgery is different for each person. The two most common side effects from surgery are pain and scarring.

Pain

Surgery causes temporary pain in the area of the operation. You may be uncomfortable during the first few days after surgery, but pain can be controlled with medications. Discuss pain relief with your doctor or nurse.

Scarring

Any skin surgery leaves scars. The same is true for surgery to remove skin cancer. The size and color of the scar depend on the size of the cancer, its location, the type of surgery, and how well your skin heals. Your doctor will use techniques to hide the scar as much as possible. If stitches were needed to hold the wound closed, they are usually removed about a week after surgery. Healing progresses steadily after that. Early on, the scar may be red or bumpy. It takes about a full year for a scar to finish fading. Be sure to speak with your doctor about ways to aid healing. Most often, though, your body's natural healing abilities are the most powerful and simply take time.

Skin grafts are sometimes needed to close an opening in the skin left by surgery and to leave a cosmetically pleasing appearance. The surgeon numbs and removes a patch of healthy skin from somewhere else in the body, such as the upper thigh or abdomen. The patch is then used to cover the wound. If you have a skin graft, you may receive special instructions about how to care for it until it heals.