Skin Cancer Surgery

Skin Cancer Excision

What Is Skin Cancer Excision?

Skin cancer excision is a surgical procedure used to remove various types of skin cancers that do not meet the medical criteria for Mohs surgery, often based on Appropriate Use Criteria (AUC). This procedure involves excising the cancerous tissue along with a margin of healthy skin to ensure complete removal of the cancer cells. The margin typically ranges from 4-5 mm around the skin cancer or the biopsy site. Skin cancer excision is commonly used for treating basal cell carcinoma, squamous cell carcinoma, melanoma, and certain benign skin lesions such as atypical nevi with moderate to severe cytological atypia, which are recommended for complete removal following a biopsy.

Types of Skin Cancers Treated

Standard wide local excision is effective for treating several types of skin cancers, including:

• Basal Cell Carcinoma (BCC): The most common type of skin cancer, BCC usually appears as a translucent bump but can also manifest as a flat, scaly patch.
• Squamous Cell Carcinoma (SCC): SCC often presents as a firm red nodule or a flat lesion with a scaly, crusted surface and tends to grow more rapidly than BCC.
• Melanoma: A serious form of skin cancer that can develop from pre-existing moles or new growths, characterized by irregular shapes, colors, and borders.
• Benign Skin Lesions: Atypical nevi (moles) with moderate to severe cytological atypia, which are often recommended for complete excisional removal after biopsy to prevent potential progression to melanoma.

Initial Biopsy vs. Excision

The initial biopsy and excision procedures serve different purposes in the diagnosis and treatment of skin lesions. An initial biopsy is a diagnostic procedure where a small sample of the suspicious skin lesion is taken for pathological examination. The primary goal is to determine the nature of the lesion, whether benign or malignant, without necessarily removing the entire lesion. This is usually done using a punch, shave, or incisional biopsy technique.

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In contrast, excision is a therapeutic procedure aimed at completely removing the skin lesion of concern along with a margin of healthy tissue. This method is used once a diagnosis has been confirmed or if the lesion has been identified as needing complete removal due to its malignant or atypical nature. The intent and technique in excision are focused on ensuring that no malignant cells are left behind, thereby reducing the risk of recurrence.

The Procedure

The excision procedure is straightforward and usually takes around 30 minutes. It is typically performed under local anesthesia, which numbs the area to ensure patient comfort. The surgeon marks the cancerous area and an appropriate margin around it. The marked tissue is then carefully excised with a scalpel. The excised tissue is sent to a pathology lab to confirm complete removal of the cancer. The resulting wound is then sutured closed. Depending on the size and location of the excision, the sutures may either be dissolvable or require removal about two weeks later.

Mohs Day with Reconstruction

After the cancerous tissue has been completely removed, the reconstruction phase begins. The type of repair or reconstruction depends on the size and location of the wound, as well as the patient's ability to tolerate additional procedures. Reconstruction options may include linear repair, flap surgery, grafting, or allowing the wound to heal by secondary intention (granulation). Some reconstructions can be performed on the same day as the Mohs surgery, while others may be scheduled for a subsequent day. The goal of reconstruction is to restore both function and cosmetic appearance, ensuring the best possible outcome for the patient.

Length of the Procedure

The duration of Mohs surgery varies depending on the depth and extent of the skin cancer. Simple cases where the cancer is shallow and confined to a small area may be completed within a few hours. However, more complex cases with deeper or more extensive cancer can take longer, sometimes requiring multiple stages of tissue removal and examination. Each stage of the procedure, including tissue removal, mapping, and microscopic examination, takes about 30-60 minutes. Patients should be prepared for a full day at the clinic, as the precise nature of Mohs surgery prioritizes thoroughness over speed to ensure complete cancer removal.

Aftercare and Recovery

After the procedure, patients receive detailed aftercare instructions to promote healing and minimize the risk of infection. It is important to keep the surgical site clean and dry. Patients should avoid strenuous activities that could stress the incision and follow any specific instructions provided by the surgeon, such as applying antibiotic ointment and changing dressings regularly. Mild discomfort and swelling are common and can be managed with over-the-counter pain relievers.

Follow-Up and Results

Follow-up care is crucial to ensure proper healing and to monitor for any signs of recurrence. Patients typically return to the clinic about two weeks after the procedure to have their sutures removed if non-dissolvable sutures were used. During this visit, the surgeon will assess the healing process and address any concerns the patient may have. The pathology results are also reviewed to confirm that the cancer has been completely excised. In cases where additional treatment is necessary, further steps will be discussed with the patient.

Benefits and Risks

Skin cancer excision offers several benefits, including a high cure rate for low-risk skin cancers and a relatively quick and simple procedure with minimal downtime. The main risks associated with skin cancer excision are similar to those of any surgical procedure, including infection, scarring, and bleeding. However, these risks are generally low, and proper aftercare can further minimize them. Patients should discuss any concerns or potential risks with their dermatologist before the procedure.

Insurance Coverage

Skin cancer excision is typically covered by insurance, as it is considered a medically necessary procedure for the treatment of skin cancer. Patients should check with their insurance providers to understand their specific coverage details and any potential out-of-pocket costs. The team at True Dermatology can assist with insurance inquiries and provide the necessary documentation to facilitate coverage.