Skin Cancer: Basal and Squamous Cell

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Treating Skin Cancer - Basal and Squamous Cell TOPICS

Surgery for basal and squamous cell skin cancers

Many different kinds of surgery can be used 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.

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). The area is then treated with an electric needle (electrode) to destroy any remaining cancer cells. This process is often repeated once or twice during the same office visit. 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)

Mohs surgery is sometimes used when there is a high risk of the skin cancer coming back after treatment, when the extent of the skin cancer is not known, or when the goal is to save as much healthy skin as possible, such as with cancers around the eye. It is done by a specially trained surgeon.

Mohs can often offer better outcomes than some other forms of surgery and other treatments. But it’s also usually more complex, time-consuming, and expensive than other methods. In recent years, skin cancer experts have developed guidelines for when it’s best to use this technique based on the type and size of skin cancer, where it is on the body, and other important features.

Using the Mohs technique, the surgeon removes a very thin layer of the skin (including the tumor) and then checks the outer edges of 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 can help the area look better after surgery.

Lymph node surgery

If lymph nodes near a squamous or basal cell skin cancer are growing larger, doctors will be concerned that the cancer might have spread to these lymph nodes. One or more nodes may be biopsied (see the section “How are basal and squamous cell skin cancers diagnosed?”), or many nodes might be 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). You can learn more in our document Lymph Nodes and Cancer.

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 fluid from the legs and arms drain back toward the heart. 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 basal or squamous cell 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.


Last Medical Review: 10/21/2013
Last Revised: 02/20/2014