Skin Cancer Lesion Surgery

Surgical Removal for Melanoma

Surgical removal of the melanoma is the most common treatment. This approach offers:

• High cure rates
• Is immediate
• Margins are checked to confirm complete removal
• The presence of any invasive component can be accurately assessed guiding further treatment

In more advanced skin cancers, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells are cleared.

Typically, where sutures are used, they are removed soon afterwards.

Wide Local Excision – Typically is performed on the site after the melanoma has been diagnosed on excisional biopsy. This is to reduce the risk of the melanoma returning at the same site in the future.

The desired safety margins are determined by the type of melanoma to be between 5mm and 20mm based on the level of invasion and a second excision known as a wide-area local excision is performed to achieve this amount of safety margin around the melanoma excision site. In cases of superficial spreading melanoma, the desired margin is 5 mm to the side and deep, and highly invasive melanomas may require up to 20mm margins to the side and deep to reach the lowest risk of spread or local recurrence.

Lesions are excised under either general anaesthetic or local anaesthetic. Where wide local excision is performed a larger area excised and often this is more comfortable under general anaesthesia. Occasionally flap repairs or skin grafts may be required to allow the wound to heal.

The lesion is marked pre-operatively, excised with a margin of normal tissue and sent for pathology. The wound is closed with absorbable sutures.

Occasionally flap repairs or skin grafts may be required to allow the wound to heal.

Sentinel Lymph Node Biopsy

One of the ways in which Melanoma can spread is via the lymphatic system to lymph nodes usually near the Melanoma itself.

Deeper or larger melanomas have increased risk of lymph node involvement.

A technique to sample the lymph nodes near the Melanoma and check for cancer involvement is called a sentinel lymph node biopsy.

The procedure involves using a combination of a nuclear medicine scan following an injection of tracer near the site of the melanoma and an injection of blue dye taken up by the lymphatics. This then identifies the initial lymph nodes that drain the particular area where the Melanoma is located. The site is marked.

A small incision is made over where the lymph nodes are located and upto 3 lymph nodes are removed and sent for examination. This procedure is performed in combination with a wide local excision of the melanoma.

Advantages of performing a sentinel lymph node biopsy include more accurately determining prognosis, early identification of lymph node disease and early administration of additional treatment for lymph node positive disease

Surgical Removal for Squamous Cell Carcinoma/ Basal Cell Carcinoma

Surgical removal of Basal Cell Carcinoma is the most common treatment. Non-melanoma skin cancers are almost always surgically removed under local anaesthetic. This approach offers:

• The highest cure rates
• Is immediate,
• Lesions margins are checked to confirm complete clearance

In more advanced skin cancers, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells are cleared.

Excision Treatment Process - After careful administration of local anaesthetic, the Doctor uses a scalpel to remove the entire growth, along with surrounding apparently normal skin as a safety margin.

The wound around the surgical site is then closed with sutures (stitches).

Excision Treatment Recovery - For a few days post excision there may be minor bruising and swelling. Scarring is usually minimal. Pain or discomfort is minor.

Typically, where sutures are used, they are removed soon afterwards.

Surgical Excision Prognosis - Studies indicate the cure rate for primary tumours with this technique is about 92%. This rate drops to 77% for recurrent Basal Cell Carcinomas.

A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

Risks of skin lesion excision

All surgeries have risks. Skin lesion excision is a low risk procedure. Some potential risks include;

• Wound infection
• Need for further surgery ( involved margins or recurrence)
• Abnormal scarring
• Bleeding

After Skin Lesion Surgery

Surgery is usually performed as a day case at the hospital.

Often simple pain relief such as paracetamol or ibuprofen is all that is required.

Wounds are closed with sutures that are usually absorbable and waterproof dressings applied. Specific wound care advice will be given on the day of your surgery.

An appointment will be made for follow up of results and review of wounds

Should you experience any increasing pain, redness or swelling please contact the rooms during business hours or seek a review with your local doctor to exclude or treat any potential wound infection