Skin Cancer Surgery

Skin cancer can be a life-threatening condition if left untreated. However, it can be easily treated if diagnosed in the early stages. Skin cancer is mainly of three types, namely:

• Squamous cell carcinoma: Cancer of the outer layer of the skin (epidermis).
• Basal cell carcinoma: Cancer of the bottom layer of the epidermis
• Malignant melanoma: Cancer that starts from the skin and later spreads to other body parts

Squamous and basal cell are the most common types of skin cancer, while malignant melanoma is less common.

Although many treatment options exist, surgery is still a common method for the treatment of skin cancer. The different surgical techniques for skin cancer include wide local incision, cryosurgery, curettage and electrosurgery, and Mohs surgery.

A surgeon will recommend skin cancer surgery to remove any of the three types of skin cancer. Here are some symptoms of skin cancer as per their type:

• Squamous cell carcinoma: This cancer is most commonly found on the neck, face, bald scalp, lower legs, arms, and back of hands. This cancerous growth may raise the skin in the affected area, and look scaly with a crusty, hard cap. It is usually tender to the touch and may even bleed sometimes.
• Basal cell carcinoma: It can develop anywhere in the body, especially on the neck and face. The cancerous growth may look like a flat spot that is itchy and crusty. It may also appear as a red, firm lump and bleed at times. It may appear to heal, although it never heals completely.
• Melanoma: The skin growths or spots seen in melanoma change in colour, shape, and size over time. They also look different than any other spots present in the body. You may observe bleeding, oozing, and scaling. Changes in sensation (pain and itchiness) in that particular area are also experienced.

The risk of developing skin cancer is more in individuals who:

• Have light-coloured hair, skin, and eyes
• Have a weak immune system Read more: How to improve immunity
• Spend a substantial amount of time under the sun
• Have a family member with skin cancer

There are no absolute contraindications to most of the procedures employed for skin cancer surgery. However, the doctor may not recommend cryosurgery in individuals with:

• Multiple myeloma
• Cold urticaria
• Cryoglobulinaemia
• Raynaud disease
• History of cold-induced injury in the area of surgery
• Poor blood circulation in the area of surgery

Before the surgery, the surgeon may perform the following imaging tests and procedures to examine the spread of cancer within the body:

• Lymphadenectomy (removal of lymph nodes)
• Magnetic resonance imaging (MRI)
• Ultrasound
• Computerised axial tomography (CAT) scan

The surgeon may ask you to do the following before for the surgery:

• Share the list of all the medicines (including herbal supplements) that you take with them.
• Share information about any allergies that you may have, especially to general or local anaesthesia and contrast agents used in imaging.
• Discontinue taking medicines like ibuprofen, aspirin, or naproxen a few weeks before surgery and two days following surgery as they may increase the risk of excessive bleeding.
• Discontinue taking any blood-thinning medicines and non-steroidal anti-inflammatory drugs.
• Avoid smoking two weeks before and after the surgery as it can affect wound healing.
• Inform the surgeon if you are pregnant to avoid the risk of exposing the baby to radiation.
• Discontinue taking the following substances one week prior to surgery, as these are associated with a rise in blood pressure and increased risk of bleeding:
  • Garlic
  • Fish oil
  • Vitamin C and vitamin E
  • Ginseng
  • Ginkgo biloba
• Avoid drinking alcohol one day before the surgery and after as it can raise your blood pressure and increase the chances of bleeding.
• Arrange someone to drive you home after surgery.

On the day of the surgery, take care of the following:

• Take a shower and clean the site of operation to reduce the risk of infections.
• Take all your prescription medicines allowed by the surgeon and have a regular breakfast.
• Do not wear make-up on your face if the surgery has to be performed on the face.
• Wear loose-fitting, comfortable clothes for the hospital.

After admission to the hospital, you will be given a hospital gown to change into. The choice of procedure for skin cancer surgery depends on the type, size, location, and other factors related to skin cancer. The surgery is most often performed under local anaesthesia, medicine that numbs a specific area of the body. It is usually performed either in a hospital clinic or doctor’s office. The different surgeries that can be employed to remove skin cancer are:

Wide local incision: This procedure is used to remove large skin cancers. All three types of skin cancer can be treated by this procedure. Here, the cancerous tissue along with a rim of healthy, normal tissue surrounding the cancer cells is removed. The surgery is tolerated well, and the pain experienced after surgery can easily be managed with pain-relieving medicines. You will be allowed to go home on the same day as the procedure.

Mohs surgery: It is considered to be a gold-standard treatment for skin cancer. This surgery has the highest cure rate among the skin cancer treatments. It lasts for about three to six hours. During the procedure, the surgeon will scrape the layer of cancerous tissue one by one and examine it under a microscope to detect cancer cells. He/she will keep removing your skin layers until your skin shows no sign of cancer, then the surgeon will close the surgical site with stitches, and place a dressing over it. 

Cryosurgery: This is less invasive than other skin cancer surgeries. Cryosurgery is used to remove skin cancers limited to a small area. It is also associated with minimal bleeding and pain and has a short recovery period. During this procedure, the surgeon will use a needle-like applicator through which he/she will spray high-pressure argon gas or liquid nitrogen onto the cancerous tissue to freeze and destroy it. In about one month, the destroyed tissue will form a scab and fall off your body.

Curettage and electrosurgery: This procedure is used for the treatment of small, well-defined skin cancers and is associated with a high cure rate. For this procedure, the surgeon will remove the cancerous tissue with a spoon-shaped instrument called a curette. After removing the tissue, he/she will remove the residual cancer cells and control bleeding with the help of electrosurgery (burning the remnant tissue with an instrument that passes controlled electric current to the area). Finally, the surgeon will cover the wound with an antibiotic dressing. This procedure may be performed along with other skin cancer surgeries such as cryosurgery.

If a deep cancerous tissue has been removed at the time of surgery, the surgeon will reconstruct the operated area with skin from your groin or thigh. They may either use a skin graft or skin flap to repair the affected skin. You may also require additional cosmetic surgeries to improve your skin appearance. If there is a high risk of spreading of cancer cells, the surgeon may perform additional treatments apart from surgery, such as chemotherapy and radiation therapy.

You are will be susceptible to infection during the initial one month following surgery. The surgeon may prescribe antibiotics for the same. In addition, you may need to follow certain measures recommended by the surgeon to minimise the possibility of infection. These include:

• Do not remove the bandage for a day following surgery.
• Avoid immersing your wound in water unless allowed by the surgeon. Hence, avoid swimming or showering.
• Keep the area around the wound clean. Wash the operated area with antiseptic soap (liquid), only after getting permission from the surgeon.
• Use petroleum-based ointments to keep the surgical site moist as dry skin can delay the healing process.

The surgeon may prescribe some pain medications if you experience mild pain after the surgery. You will be asked to avoid physical activities for one to two weeks. The recovery period usually varies, depending on the type and size of cancer tissue, and whether lymphadenectomy was performed.

Unlike other treatment options, Mohs surgery helps to identify the area of the skin when the cancer is no more present. Hence, Mohs surgery has the benefit over other surgeries in preserving as much healthy tissue as possible during surgery. Moreover, this surgery has a high cure rate compared to other treatments.

When to see the doctor?

Contact the surgeon if you observe any of the complications following surgery:

• Bleeding
• Pain
• Swelling
• Loss of skin graft

This surgery is associated with the following risks:

• Pain at the surgery site
• Bleeding, swelling or crusting of the operated area
• Infection of the surgical wound
• Loss of the skin graft
• Scarring
• Recurrence of cancer

You may need to visit the hospital five to seven days after the surgery to remove skin sutures if you have any.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.