Skin cancer excision: what happens, risks and recovery

Basal cell and squamous cell carcinomas grow locally and are usually curable when removed completely. The NHS describes cutting out the cancer and some surrounding healthy skin as the main surgical treatment, with the specialist team making an individual plan. Because the removed tissue can be examined under a microscope, surgery also gives a firm diagnosis and a check that the whole cancer has come out.

Not every skin cancer needs a standard excision. Skin Health Info says surgery can be deferred when a basal cell carcinoma is slow growing in a low-risk site, or when the person cannot safely have or recover from the procedure. The NHS lists freezing (cryosurgery), radiotherapy for large cancers or people who cannot have surgery, photodynamic therapy and creams for superficial cancers as other options. Melanoma is treated differently and is covered on its own pages.

For cancers with unclear edges, in sensitive areas such as the eyelids, nose, ears and lips, or that have come back, the British Association of Dermatologists says Mohs micrographic surgery may be recommended. There is a separate guide to that technique.

You will have had a biopsy or a clinical assessment first, and the surgeon explains the plan, including how large a scar to expect and how the wound will be closed. It is fine to ask for the plan to be drawn or explained on a mirror, since the site can be hard to picture.

Tell the team about blood-thinning medicines and any allergies to local anaesthetic or dressings. The British Association of Dermatologists says to arrange transport after Mohs surgery, and it is sensible to do so after any procedure on the face or hands.

• Bring a list of your medicines and ask which to continue.

• Eat normally unless told otherwise, as local anaesthetic does not require fasting.

• Wear clothing that gives easy access to the area being treated.

• Ask who will remove the stitches and when.

The area is cleaned and numbed with injections that sting briefly. You stay awake, and may feel pressure or tugging but not sharp pain. The surgeon outlines the cancer and a margin of normal skin, cuts out the tissue, and stops any bleeding.

Skin Health Info says the wound can then be closed with direct stitches, with a skin graft taken from another part of the body, or left to heal naturally. For wounds on the face and other tricky sites, a skin flap or a referral to a reconstructive team is sometimes needed, as the Mohs information describes.

The specimen goes to a laboratory, and the report on the margins tells the team whether all of the cancer was removed. If it was not, a further procedure may be offered.

Common effects are bruising, tenderness and swelling for a few days, with a permanent scar. Less often the wound bleeds, becomes infected or opens, and nerves in the area can be affected, causing numbness. A Cambridge leaflet adds that some scars become raised, called hypertrophic or keloid scars, and may need steroid treatment.

The British Association of Dermatologists lists bleeding and bruising as the more common risks, with infection, nerve damage and recurrence of the cancer as rare ones. No percentages were stated on the pages retrieved for this guide, so ask your surgeon for figures that fit your type of cancer and site.

A cancer that is only partly removed can regrow. This is the reason for the laboratory check of the margins, and for follow-up appointments in higher-risk cases.

Cambridge advises leaving the first dressing on for 48 hours, then keeping the wound clean, patting it dry and avoiding vigorous exercise, swimming and heavy lifting until the stitches are out. Non-dissolvable stitches typically come out in 7 to 14 days depending on the site, and dissolvable ones begin to go in one to two weeks.

Oxford says wounds remain weak for up to six weeks and then mature over more than a year, and recommends daily moisturising and massage of the healed scar and sun protection of factor 50 over it. After skin cancer treatment, protecting the skin from sun is advice that continues for life.

Skin Health Info says most people with a low-risk basal cell carcinoma do not need ongoing hospital follow-up, while those with advanced disease or a weakened immune system usually do. It also suggests monthly checks of your own skin so new or changing areas are noticed early. See your GP about any new lump, sore that does not heal, or change in a mole.

Increasing redness, spreading heat, worsening pain, discharge or a fever in the first days can mean infection, and the GP or treating clinic should be contacted promptly. For bleeding, Cambridge advises firm pressure over the dressing for fifteen minutes, then help from the GP or emergency department if it does not stop. NHS 111 can advise out of hours.