Skin cancer surgery

Surgery is the most common treatment for skin cancer. How it is done depends mostly on the size of the cancer.

 

Small cancers can often be removed by cutting them out (excision), or by a technique known as curettage and electrocautery .

Larger tumours are more likely to be cut out (excised) and the skin replaced with a skin graft or a skin flap if necessary.

Excision

Many small skin cancers are removed by simple surgery. The surgeon or dermatologist will remove the lump and also some normal-looking skin around it to try to make sure that the cancer has completely gone.

You will have stitches that may need to be removed 5-14 days after your operation. Sometimes surgeons use stitches that dissolve and don’t need to be removed.

Most operations will be done under local anaesthetic and you’ll probably be able to go home the same day. The wound will be covered by a dressing. The staff at the hospital will explain how to take care of the area and the dressing. If necessary, they can arrange for your district nurse to change your dressings at home.

Skin grafts and skin flaps

If the tumour is large or spreading, a larger area of skin may have to be removed. You may then need a skin graft skin graft or, less commonly, a skin flap to cover the wound. Skin grafts and flaps are layers of skin taken from another part of the body and placed over the area from which the skin cancer has been removed.

A skin graft is a very thin layer of skin. The surgeon (often a plastic surgeon) will take a layer of skin from another part of the body (known as the donor site). The inner thigh is a common place from which to take the skin. It is then put over the area where the cancer has been removed.

A skin flap is a slightly thicker layer of skin which is taken from an area very close to the wound where the cancer has been removed. The flap is cut away but left partly connected so it still has a blood supply. It is moved over the wound and stitched in place. This is a very specialised type of surgery and you may have to travel to a different hospital to have it.

If you have a skin graft you can probably go home the same day. But if the graft is large, or if you have a skin flap, you may have to stay in hospital for up to four days. You may also have to stay in hospital if you have other health problems. With a skin graft you will normally have a dressing over the area to press the graft down. This helps it to create a good blood supply from the blood vessels underneath.

A skin graft for the face will usually be taken from behind the ear or the neck area to try to get a good match for the skin colour. The area where the graft has been placed will look very noticeable to begin with, but will heal within about two weeks or so. It will then fade so that it is less obvious.

Sometimes a graft is taken from the thigh area: this takes about two weeks or more to heal and may be a bit sore. The area from which the graft was taken will also become less noticeable when it has healed.

Curettage and electrocautery

This means scraping away the cancer and using heat or electricity to stop any bleeding. First you will be given a local anaesthetic. When the area is numb, the doctor will scrape away the cancer using a spoon-shaped instrument called a curette. An electrically heated loop or needle is then applied to cauterise the wound (stop any bleeding) and destroy any remaining cancer cells. Usually this treatment gives good cosmetic results. A few people may develop some scarring which may be more noticeable if you have fair skin.

Removing lymph glands

If there is evidence that squamous cell cancer has spread, you may need to have some lymph glands removed. This operation, called a lymphadenectomy, is done to see whether there are any cancer cells in the lymph glands. If cancer cells are present, removing the lymph glands can also help to prevent further spread. This is quite a large operation and is done under a general anaesthetic.

It is only necessary for a very small number of people who have squamous cell cancer and is not done for patients with basal cell cancer as these types of skin cancer almost never spread to the lymph nodes.

After a lymphadenectomy, you will have tubes (drains) in place to allow fluid to drain from the wound. These will be removed a few days after the operation.

Occasionally this operation may cause swelling of the affected area. The swelling is called lymphoedema and happens because lymph fluid cannot drain properly from the area after the lymph nodes have been removed.

 

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