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Surgery for non-melanoma skin cancer
Surgery is the primary treatment for non-melanoma skin cancer. Surgery is used to potentially cure the cancer by completely removing the tumour along with a margin of healthy tissue around the tumour.
The type of surgery done depends mainly on the:
- type of non-melanoma skin cancer
- size of the tumour
- stage of the cancer and whether it is primary or recurrent
- location of the tumour
For most people, surgery will be the only treatment needed. Side effects of surgery depend on the type of surgical procedure.
Surgical excision is a common treatment for non-melanoma skin cancer. In many cases, the tumour is completely removed during biopsy (excisional biopsy) and this is the only treatment that is needed. If the tumour is not completely removed during biopsy, then an additional surgery is necessary.
Surgical excision is used to treat most small, low-risk tumours. The entire tumour is removed along with a margin of healthy tissue around it. The margin size will vary depending on the type, size and location of the tumour. Margin size can range from 3 mm to 15 mm. The current recommended margin for low-risk BCC tumours is 3–5 mm. For low-risk SCC tumours, a margin of 4 mm is recommended. For high-risk tumours, the margins are larger.
- Surgical excision of a tumour can be done in the doctor’s office or in a hospital on an outpatient basis.
- Local anestheticanestheticA drug that causes anesthesia (the loss of some or all feeling or awareness). is used to freeze the area.
- The tumour, along with a margin of normal tissue around it, is removed.
- The tissue is sent to the laboratory for evaluation under a microscope.
- The wound is closed using stitches or staples. Larger tumours may require reconstruction using a skin graft or skin flap.
- Generally, excision will leave a scar, which will likely fade over time.
Curettage and Electrodesiccation
Curettage and electrodesiccation is a common treatment for non-melanoma skin cancer. It involves scraping away the tumour and using an electric current to stop the bleeding. It is used to treat small (less than 2 cm in diameter) superficial or distinct basal cell carcinomas and in situ squamous cell carcinomas.
Curettage and electrodesiccation is not used to treat tumours in areas that are at high risk of recurrence, such as the nose, eyelids, lips, ears, scalp and temple. This is because there is no way to know if the tumour has been completely removed with this type of treatment.
- Local anesthetic is used to freeze the area.
- The tumour is removed by scraping it with an instrument called a curette.
- Then the area (tumour bed) is treated with an electric current to destroy any remaining cancer cells and to control bleeding.
- This procedure is usually repeated 2 or 3 times.
- The treatment usually has good cosmetic results, but a few people may develop some scarring.
Mohs surgery is a specialized surgical method used to treat certain types of non-melanoma skin cancer. It has the highest cure rate of all surgical treatments.
Mohs surgery removes the tumour and surrounding tissue layer by layer until the tissue is completely clear of cancer cells when examined under a microscope. This method of tumour removal makes sure that all the cancer cells are removed while saving the maximum amount of healthy tissue.
Mohs surgery is generally used to treat:
- tumours that have a high risk of recurrence
- tumours in areas where it is essential to remove as little tissue as possible, such as the eyelid, ears, nose, lips, hairline, genitals, fingers or toes
- larger skin cancers (greater than 2 cm in diameter)
- recurrent tumours
- tumours occurring in sites of previous radiation therapy
- aggressive tumours
- tumours in people with weakened immune systems
- tumours with poorly defined borders
- tumours that invade bone or cartilage
Lymph node removal
Lymph node removal involves surgery to remove the lymph nodes in the area near a tumour. If the lymph nodes near a tumour are enlarged or if there is concern that the cancer has spread to the lymph nodes, they will be removed and checked for cancer. It is uncommon for non-melanoma skin cancer to spread. Squamous cell carcinoma and Merkel cell carcinoma are more likely to spread than other types of non-melanoma skin cancer.
Surgery to remove the lymph nodes damages the normal draining pathways for lymph fluid and can cause a buildup of fluid called lymphedema. This is an uncomfortable side effect and may last a long time. Therefore, complete removal of the lymph nodes is only done when necessary to treat the person.
Depending on the location of the tumour, different lymph nodes will be removed:
- axillary lymph nodes (in the armpit)
- inguinal and iliac lymph nodes (in the groin)
- cervical lymph nodes (in the neck)
Reconstructive surgery helps to restore the structure and appearance of the body. For non-melanoma skin cancer that covers a large area, a skin graft or skin flap may be used to repair damage caused by the excision of skin tumours. Skin grafts or flaps may also be used to where there is not enough skin to cover or close the wound.
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