Surgery for basal and squamous cell skin cancers

There are many different kinds of surgery for basal cell and squamous cell skin cancers. The options for surgery depend on how large the cancer is, where it is on the body, and the specific type of skin cancer. In most cases 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.

Simple excision

This is similar to an excisional biopsy (described in the section called “How are basal and squamous cell skin cancers diagnosed?”), but in this case the diagnosis is already known. 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. The remaining skin is carefully stitched back together, leaving a small scar.

Curettage and electrodesiccation

This treatment removes the cancer by scraping it with a curette (a long, thin instrument with a sharp looped edge on one end), then treating the area with an electric needle (electrode) to destroy any remaining cancer cells. This process is often repeated. Curettage and electrodesiccation is a good treatment for superficial (confined to the top layer of skin) basal cell and squamous cell cancers. It will leave a small scar.

Mohs surgery (microscopically controlled surgery)

Using the Mohs technique, the surgeon removes a very thin layer of the skin (including the tumor) and then checks the sample under a microscope. If cancer cells are seen, the next layer is removed and examined. This is repeated until the skin samples are found to be free of cancer cells. This process is slow, often taking several hours, but it means that more normal skin near the tumor can be saved. This creates a better appearance after surgery

Lymph node surgery

If lymph nodes near a non-melanoma skin cancer (especially a squamous cell or Merkel cell carcinoma) are growing larger, doctors will be concerned that the cancer might have spread to these lymph nodes. The nodes may be biopsied (see the section, “How are basal and squamous cell skin cancers diagnosed?”) or 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 involved than surgery on the skin, and usually requires general anesthesia (where you are asleep).

Lymphedema, a condition in which excess fluid collects in the legs or arms, is a possible long-term side effect of a lymph node dissection. Lymph nodes in the groin or under the arm are part of the lymph system, which normally helps drain fluid from the legs and arms. If the lymph nodes are removed, fluid may build up, causing these limbs to swell. If severe enough, it can cause skin problems and an increased risk of infections in the limb. Elastic stockings or compression sleeves can help some people with this condition. For more information, see our document, Understanding Lymphedema (For Cancers Other Than Breast Cancer).

Skin grafting and reconstructive surgery

After removing large non-melanoma skin cancers, it may not be possible to stretch the nearby skin enough to stitch the edges of the wound together. In these cases, healthy skin may 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 can also be helpful in some cases.