Surgery for Basal and Squamous Cell Skin Cancers

Surgery is a common treatment for both basal cell cancers (BCCs) and squamous cell cancers (SCCs) of the skin. Different surgical techniques can be used. The options depend on the type of skin cancer, how large the cancer is, where it is on the body, and other factors. Most often the surgery can be done in a doctor’s office or hospital clinic using a local anesthetic (numbing medicine).

For skin cancers with a high risk of spreading, surgery sometimes will be followed by other treatments, such as radiation or chemotherapy.

Standard excision

A standard excision is similar to an excisional biopsy, but in this case the diagnosis is already known, and a slightly wider margin of normal skin might be removed along with the tumor.

For this procedure, the skin is first numbed with a local anesthetic. The tumor is then cut out with a surgical knife, along with some surrounding normal skin. This is done by making a wedge-shaped incision around the tumor that is deep enough to get underneath it. Most often, the remaining skin is then carefully stitched back together.

This type of surgery will leave a scar.

Shave excision

A shave excision is similar to a shave biopsy, but in this case the diagnosis is already known, so the doctor will likely remove deeper layers of skin to help make sure the tumor has been removed completely.

For this procedure, the skin is first numbed with a local anesthetic. The doctor then uses a small surgical blade to shave off the top layers of the skin (including the tumor). Bleeding from the biopsy site is then stopped by applying an ointment or a chemical that stops bleeding, or by using a small electrical current to cauterize the wound.

A shave excision might be a good option for low risk basal cell and squamous cell cancers.

This treatment will likely leave a small scar.

Curettage and electrodesiccation

In curettage and electrodesiccation, the doctor removes the cancer by scraping it with a long, thin instrument with a sharp looped edge on one end (called a curette). The area is then treated with an electric needle (electrode) to destroy any remaining cancer cells. This process is often repeated once or twice during the same office visit.

Curettage and electrodesiccation might be a good option for superficial (confined to the top layer of skin) basal cell and squamous cell cancers that don’t have any high-risk features.

This treatment will likely leave a scar.

Mohs surgery and related techniques

Mohs surgery (also known as Mohs micrographic surgery, or MMS) is sometimes used to treat BCC or SCC when:

• There is a high risk the skin cancer will come back after treatment
• The extent of the skin cancer is not known
• The goal is to save as much healthy skin as possible (such as with cancers near the eye or other critical areas such as the central part of the face, the ears, or fingers)
• Standard excision (see above) wasn’t able to remove a cancer completely

The Mohs procedure is done by a surgeon with special training. First, the surgeon removes a very thin layer of skin (including the tumor), which is rapidly frozen, stained, and then checked under a microscope. If cancer cells are seen, another layer is removed and checked. This is repeated until the skin samples are free of cancer cells. This is a slow process, often taking several hours, but it means that more normal skin near the tumor can be saved. This can help the area look better after surgery.

Mohs often results in better outcomes than some other forms of surgery and other treatments. But it’s also usually more complex and time-consuming than other methods. In recent years, skin cancer experts have developed guidelines for when it’s best to use this technique based on the type and size of skin cancer, where it is on the body, and other important features.

Mohs surgery is the most common type of micrographic technique (sometimes called peripheral and deep en face margin assessment or PDEMA), but there are others. Other techniques might differ slightly in how the surgery is done, how the tumor samples are processed, or how long the procedure might take. But they all allow the surgeon to check the edges (margins) of the removed tumor sample and then remove more layers of tissue if needed.

Lymph node surgery

If lymph nodes near a squamous or basal cell skin cancer are enlarged, the doctor might biopsy them to check for cancer cells (see Tests for Basal and Squamous Cell Skin Cancer).

Sometimes, many nodes might be removed in a more extensive operation called a lymph node dissection. The nodes are then looked at under a microscope for signs of cancer. This type of operation is more extensive than surgery on the skin and is usually done while you are under general anesthesia (in a deep sleep).

Lymphedema, a condition in which excess fluid collects in an arm or leg, is a possible long-term side effect of a lymph node dissection. If it’s severe enough, it can cause skin problems and an increased risk of infections in the limb. Talk to your doctor about your risk of lymphedema. It’s important to know what to watch for, and to take the steps to help reduce your risk.

Skin grafting and reconstructive surgery

After surgery to remove a large BCC or SCC, it may not be possible to stretch the nearby skin enough to stitch the edges of the wound together. In these cases, healthy skin can be taken from another part of the body and grafted over the wound to help it heal and to restore the appearance of the affected area. Other reconstructive surgical procedures, such as moving 'flaps' of nearby skin over the wound, can also be helpful in some cases.