Surgery for non-melanoma skin cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body. This usually means cutting into the body, but surgery to remove cancer can also be done in different ways, such as using cold or heat.

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 the only treatment you have or it may be used along with other cancer treatments. 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 commonly used to treat non-melanoma skin cancer.

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.

Surgical excision is used 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 (called a scalpel) to cut out the cancer from the skin. The tissue is then sent to a lab to make sure there are no cancer cells in the surgical margin.

Mohs surgery removes the cancer in layers, little by little, until no cancer remains. It is done 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’s often used for non-melanoma skin cancers on the face, ears, hands and feet.

Find out more about Mohs surgery.

Curettage and electrodesiccation (C&E) uses a sharp tool to scrape away cancer. Then an electrical current destroys any remaining cancer cells. It’s usually used for small, low-risk cancers that are only on the surface of the skin, including SCC in situ. It’s also often used for tumours on the neck, central area of the body (called the trunk), upper 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 send an electrical current directly to the area. The electrical current creates heat, which destroys any remaining cancer cells and helps control bleeding.

Cryosurgery destroys cancer cells by freezing them. Doctors apply an extremely cold liquid to the skin. The area is allowed to thaw and then is frozen again. The freeze-thaw cycle may need to be repeated a few times.

Because it treats tumours on the surface of the body, cryosurgery doesn’t usually require any cuts into the skin like standard surgeries.

Cryosurgery is mainly used to treat low-risk cancers as well as precancerous conditions. 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.

Sometimes the doctor has to remove a large area of skin to make sure all of the cancer is gone. Surgery may be needed to help improve how the skin looks after surgery to remove the cancer.

A skin graft may be done if a large area of skin was removed. The doctor removes skin from another area of the body and places it over the surgical area to cover the open wound and repair the skin.

A skin flap is a thicker piece of tissue with its own blood supply. Like a skin graft, a skin flap covers the area where the cancer was removed. The doctor rotates a nearby piece of skin to cover the open wound and flaps. A skin flap can be used to repair large wounds on the face.

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. After you have been given the anesthetic, the surgeon makes a cut to remove lymph nodes. They may also remove other nearby tissue.

Find out more about lymph node dissection.

Side effects of surgery will depend mainly on the type and site of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for non-melanoma skin cancer may cause these side effects:

• pain
• scarring
• bruising
• skin problems, such as changes to skin colour
• infection
• numbness
• lymphedema( after a lymph node dissection)

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.