Skin Cancer Removal
What is skin cancer removal?
Skin cancer removal includes various procedures to treat cancerous lesions, growths and tumors of the skin. Skin cancer removal alone may be appropriate when skin cancer is local and has not spread. It is usually part of a larger treatment plan when skin cancer has spread or is at high risk of spreading.
Skin cancer removal can be a minor procedure or a major surgery with risks and potential complications. It is only one method used to treat skin cancer. Discuss all of your treatment options with your doctor to understand which options are right for you.
Types of skin cancer removal
There are many types of skin cancer removal procedures including:
Cryosurgery freezes the tumor with liquid nitrogen. Because the cure rate is lower with this technique, your doctor may only use it in specific cases. This includes precancerous lesions and for patients who have bleeding disorders or who cannot tolerate anesthesia.
Dermabrasion removes the top layer of skin using friction. This technique may only be appropriate for very superficial lesions that have not affected deeper skin layers.
Electrodesiccation and curettage involves scraping off the tumor using a curette, a spoon-like instrument with a sharp ring on the end. Your doctor then cauterizes the wound with electric current to stop the bleeding and destroy any remaining cancer cells. He or she may repeat the process several times.
Laser surgery uses a laser beam to cut out the tumor. This technique minimizes bleeding and gives your doctor good control over the depth of the incision. Your doctor may also use laser surgery to remove precancerous lesions from the skin’s surface.
Mohs micrographic surgery involves removing the tumor layer-by-layer and examining each layer under a microscope for cancer cells. Your doctor will continue removing layers until he or she cannot find any cancer cells in the layers. This technique removes the least amount of normal tissue and best preserves the area’s appearance. It is a good technique for areas such as the ears or face.
Shave excision involves shaving the tumor or lesion off the skin’s surface with a thin blade. This procedure is appropriate for superficial cancers that have not affected deeper skin layers.
Simple or wide excision involves cutting out the tumor, some underlying tissue, and some surrounding healthy tissue. The extent of the incision will depend on the size and depth of the tumor. This may involve closing the wound with stitches.
Other procedures that may be performed
Your doctor may recommend other procedures to treat skin cancer. These include::
Biologic therapy or immunotherapy boosts or stimulates your body’s immune system to help fight cancer.
Chemotherapy is medication that kills cancer cells. Chemotherapy for skin cancer is often topical, meaning you apply it to the skin. If skin cancer has spread, systemic chemotherapy in the form of a pill or IV medication may be necessary.
Lymph node surgery involves either a biopsy or removal of nearby lymph nodes.
Photodynamic therapy combines special light-sensitive drugs with specific wavelengths of light. Your doctor injects the drug into your tumor and exposes it to the light. This produces a reaction that kills cancer cells.
Radiation therapy uses radiation to kill cancer cells and shrink tumors.
Reconstructive surgery rebuilds and restores body or facial structures disfigured by removing the cancer.
Skin grafting is the surgical transplantation of skin and its underlying tissues from one area to another. Your doctor may use skin grafting to help close your wound or minimize scarring.
Why is skin cancer removal performed?
Your doctor may recommend skin cancer removal to treat cancerous and precancerous skin conditions. Cancer occurs when old or damaged cells divide and multiply uncontrollably. Cancer cells rapidly reproduce even when your body signals them to stop.
Types of skin cancer include:
Actinic keratosis is a precursor to squamous cell carcinoma.
Basal cell carcinoma begins in the basal cells, which are the cells at the base of the epidermis (outermost layer of skin). This is the most common form of skin cancer and usually occurs on body areas that get sun exposure.
Melanoma begins in the melanocytes (pigment-making skin cells). While melanoma is highly curable in its early stages, it can spread quickly and become deadly.
Squamous cell carcinoma begins in the squamous cells, which are the cells at the surface of the epidermis. This type of skin cancer is most common on body areas that get sun exposure. However, it can occur anywhere on the body.
Who performs skin cancer removal?
The following specialists perform skin cancer removal:
Dermatologists specialize in the medical and surgical care of the skin, hair and nails.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.
Plastic surgeons specialize in correcting physical defects that affect a person's appearance or ability to function.
Physician assistants or nurses with advanced training will perform some types of skin cancer removal procedures in certain cases.
How is skin cancer removal performed?
Your skin cancer removal will be performed in a hospital, doctor’s office, or outpatient surgery clinic. Your surgeon will advise you on which type of skin cancer removal is best for you based on the type, stage and location of your skin cancer. Other factors include your age, medical history, general health, and possibly your personal preference. Learn about the different skin cancer removal procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your doctor will remove most skin cancers using a local anesthetic. Local anesthesia involves injecting an anesthetic in the skin and tissues around the surgical area. You may also receive a sedative to keep you relaxed and comfortable during the procedure.
Doctors sometimes use regional anesthesia or general anesthesia. This may be necessary for extensive surgeries that combine skin cancer removal with another procedure, such as lymph node sampling or dissection, skin grafting, or reconstructive procedures.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your skin cancer removal
A skin cancer removal procedure with local anesthesia generally includes these steps:
You will dress in a patient gown or wear your own loose-fitting clothing.
You will lie on a procedure table.
Your doctor will clean the procedure area and inject a local anesthetic to numb it.
Your doctor will remove the cancerous lesion. The steps of the procedure will vary depending on the specific procedure.
Your team will bandage or dress the incision. Stitches may or may not be necessary depending on the specific procedure.
For skin cancer surgeries that require deeper anesthesia, you can generally expect:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of skin cancer removal?
As with all surgeries, skin cancer removal involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Potential complications of skin cancer removal
Complications of skin cancer removal include:
Changes in skin color, texture or sensation
Chronic pain at the site
Damage to nerves, blood vessels, or muscles
Prolonged or poor healing
Recurrence of skin cancer
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, bloody urine, fever, increase in pain, problems with urination, or wound redness, swelling or drainage
Not smoking as this can lead to poor wound healing
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my skin cancer removal?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for skin cancer removal by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing skin cancer removal can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need skin cancer removal? Are there any other options for treating my condition?
What type of skin cancer removal will I need? What is the cure rate with this procedure?
How much scarring will I have after the procedure?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my skin cancer removal?
Knowing what to expect after skin cancer removal can help make your road to recovery as smooth as possible.
How long will it take to recover?
Most skin cancer removals are outpatient procedures involving local anesthesia. Patients generally go home right after this type of procedure.
If you had sedation or deeper anesthesia, you will stay in the recovery room until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will be drowsy from sedation or anesthesia, so you will need a friend or family member to drive you home and stay with you the first night.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Most people return to their normal activities in a day or two. Full recovery takes four to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after skin cancer removal. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to have a bowel movement or pass gas
Pain that is not controlled by your pain medication or new pain
Unexpected drainage, pus, redness or swelling of your incision
How might skin cancer removal affect my everyday life?
Skin cancer removal may cure your skin cancer, but it will not prevent more skin cancer. Once you have skin cancer, your risk of having it again is higher. You may need to have more skin cancer removal procedures in the future. You can make changes in everyday life that may help prevent or delay future skin cancers including:
Avoiding indoor tanning
Getting an annual skin cancer screening from a dermatologist
Knowing the signs of skin cancer
Performing regular self-exams
Protecting skin with long-sleeved shirts and wide-brimmed hats
Seeking shade whenever possible
Wearing sunscreen with an SPF of at least 15 and both UVA and UVB protection every day