Surgery for Squamous Cell Carcinoma of the Skin

Surgery is a common treatment for squamous cell carcinoma (SCC) of the skin, also known as squamous cell skin cancer.

For squamous cell skin cancers with a high risk of coming back or spreading, surgery sometimes will be followed by other treatments, such as radiation therapy.

Surgery options

Different types of surgery can be used to treat SCC. The options depend on how large the cancer is, where it is on the body, how likely it is to come back or spread, and other factors. Most often, the surgery can be done in a doctor’s office or hospital clinic using a local anesthetic (numbing medicine).

Any surgery is likely to leave at least a small scar. Different methods can result in different scars, so ask your doctor about possible scarring before the surgery.

Curettage and electrodesiccation

In curettage and electrodesiccation (C&E), the doctor removes the cancer by scraping it with a long, thin instrument with a sharp looped edge on one end, called a curette. 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 might be an option for some small squamous cell cancers that don’t have any high-risk features.

This treatment will likely leave a small scar.

Shave excision

A shave excision is similar to a shave biopsy, but in this case the diagnosis is already known, so the doctor will likely remove deeper layers of skin to help make sure the tumor has been removed completely.

For this procedure, the skin is first numbed with a local anesthetic. The doctor then uses a small surgical blade to shave off the top layers of the skin, including the tumor. Bleeding from the surgical site is then stopped by applying an ointment or a chemical that controls bleeding, or by using a small electrical current to cauterize the wound.

A shave excision might be an option for some low-risk squamous cell skin cancers.

This treatment will likely leave a small scar.

Standard excision (wide excision)

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. This is done by making a wedge-shaped incision around the tumor that is deep enough to get underneath it.

Compared with an excisional biopsy, a slightly wider margin of normal skin might be removed along with the tumor. The size of the margin will depend on where the tumor is and the risk that it might come back. Higher-risk cancers typically need wider margins.

Most often, the remaining skin is then carefully stitched back together. Depending on the size of the tumor, sometimes a skin flap or graft might be needed to cover the area. This is described below.

This is a common treatment for squamous cell skin cancer, especially if it appears to have grown deeper into the skin.

This type of surgery will leave a scar.

Mohs surgery and related techniques

Mohs surgery, also known as Mohs micrographic surgery (MMS), is sometimes used to treat SCC, especially when:

• There is a high risk the skin cancer will come back after treatment
• The extent of the skin cancer is not clear
• The goal is to save as much healthy skin as possible, such as with cancers near the eye or other critical areas such as the central part of the face, the ears, or fingers
• Standard excision (see above) didn’t remove the cancer completely
• The cancer has come back after treatment

The Mohs procedure is done by a surgeon with special training. It is typically done in an outpatient setting, while you are awake and the area is numbed.

First, the surgeon removes a very thin layer of skin, including the tumor. This is rapidly frozen, stained, and then checked under a microscope. If cancer cells are seen, another layer is removed and checked. This is repeated until the skin samples are free of cancer cells.

This is a slow process, 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.

Mohs is usually more complex and time-consuming than other types of surgery, but it often results in better outcomes. Because of this, it’s often the preferred type of skin surgery for SCC that is at higher risk for coming back or spreading.

Related micrographic techniques

Mohs surgery is the most common type of micrographic technique (sometimes called peripheral and deep en face margin assessment, or PDEMA), but there are others. Other techniques might differ slightly in how the surgery is done, how the tumor samples are processed, or how long the procedure might take. But they all allow the surgeon to check the edges (margins) of the removed tumor sample and then remove more layers of tissue if needed.

Skin grafting and reconstructive surgery

After surgery to remove a large SCC, it might not be possible to stretch the nearby skin enough to stitch the edges of the skin together. In these cases, reconstructive surgical procedures, such as moving flaps of nearby skin over the wound, can sometimes be helpful. Another option might be to take healthy skin from another part of the body and graft it over the area to help it heal and to restore its appearance.

Lymph node surgery

If lymph nodes near a squamous cell skin cancer are enlarged, the doctor might biopsy them to check for cancer cells (see Early Detection, Diagnosis, and Staging of Squamous Cell Carcinoma of the Skin).

Lymph node dissection

If tests show that SCC has spread to nearby lymph nodes, surgery to remove those lymph nodes might be recommended, in an 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 extensive than surgery on the skin and is usually done while you are under general anesthesia (in a deep sleep).

Lymphedema, a condition in which excess fluid collects in an arm or leg, is a possible long-term side effect of a lymph node dissection. If it’s severe enough, it can cause skin problems and an increased risk of infections in the limb. Talk to your doctor about your risk of lymphedema. It’s important to know what to watch for, and to take steps to help reduce your risk.