Skin Cancer Surgery

Non melanoma skin cancer (BCC and SCC) is the most diagnosed cancer in Australia, five times more common than all other cancers combined. By age 70, 78% of men and 58% of women in Australia will have been diagnosed with a non melanoma skin cancer.

Basal Cell carcinoma is the most common type of skin cancer. It can increase in size making its removal difficult and invade local structures. They do not metastasize.

Squamous Cell carcinoma may also cause local problems and have a potential of metastatic spread (spread to other parts of the body through the bloodstream or lymphatic system). Metastatic spread is uncommon and is dependent on the aggressiveness (grade) of the tumour and its size.

Melanoma skin cancers have a potential of distant spread proportional to there thickness as measured on the pathology sample.

Some skin cancers are suitable to treatment by topical methods. Thin skin cancers may be treated by creams/ ointments, liquid nitrogen, light treatment and other modalities. Skin cancers that are not thin (superficial) require surgery. Melanoma is treated surgically.

Skin cancer resection involves removing the cancer and a margin of normal tissue to ensure clearance. The margin of excision is determined by the type of tumour and is assessed by a Histopathologist who analyses the resection specimen microscopically. The pathology result takes up to one week to be available. For melanoma the margin of excision is proportional to the thickness of the tumour as measured by the Histopathologist and therefore an initial biopsy or narrow excision is performed to determine how much tissue is required for a second definitve resection.

Moh’s surgery is a technique by which tumours of indistinct margins are resected sequentially and undergo simultaneous pathological analysis.

Once the tumour has been removed the resulting defect may be able to be sewn closed (direct closure). In areas where there is a deficiency of skin, such as the lower leg, or in an area where this may distort local structures, such as the nose, other techniques are used to cover the defect. A skin graft or a flap can be used.

A skin graft is skin taken from another area and used to fill a defect. A flap refers to composite tissue (skin and the underlying tissue) that is moved into a defect.

A skin graft enables an area of tissue loss to be covered, a graft uses tissue of similar colour and thickness to reconstruct a defect.

Skin excisions will always leave a scar. If a scar can be placed in a favourable location (such as in an existing skin fold) and closure is without tension scars often very good. Plastic Surgeons specialise in techniques to minimalise scarring. Scars improve postoperatively for up to one year.