Surgery is a common treatment for non-melanoma skin cancers (NMSCs), including both basal cell cancers and squamous cell cancers.
If the skin cancer is a simple lesion that’s easily treatable, patients may only need to see a dermatologist. More complex or serious cases might require a team approach.
In addition to a dermatologist, a patient may need to see other specialists such as a medical oncologist, surgical oncologist, or plastic surgeon.
There are a number of surgical options available. Options depend on the type of skin cancer, where it is on the body, how large and deep the tumor grows, and other factors. In some cases, it may be the only treatment needed, says Hamann. Surgical options include:
Curettage and Electrodesiccation
A technique combining curettage (scraping) and electrodesiccation (burning) is often used for small, superficial, uncomplicated basal cell skin cancer or squamous cell skin cancer. It is typically performed on an outpatient basis in a doctor’s office with local anesthesia.
After numbing the tumor and the surrounding area, the doctor scrapes off the problematic area with a curette, an instrument with a sharp, ring-shaped tip.
Next, the physician cauterizes the site of the tumor with a small electric needle (electrode), which stops the bleeding and destroys any stray cancer cells. No stitches (sutures) are required.
The scrape-and-burn procedure may be repeated once or twice during the same office visit and can be used on multiple locations.
The method generally leaves a small scar.
Mohs Surgery
During a Mohs (microscopically controlled) procedure, a specially trained dermatologist or surgeon removes a very thin layer of skin containing the tumor.
While the patient waits, the sample is examined under a microscope to see if there are any cancer cells.
The procedure is repeated, with the doctor removing one thin layer at a time, until a tissue sample is cancer-free. The process can take several hours.
The Mohs technique is considered the gold standard for treating many squamous cell cancers, basal cell cancers, and some melanomas.
It has the highest cure rate and spares as much healthy skin surrounding the tumor as possible, leaving the smallest possible scar.
As with other skin cancer surgeries, it is typically done on an outpatient basis in a doctor’s office with local anesthesia.
But because it is so complex and time-consuming, skin-cancer experts have devised guidelines for when it is the best option.
It’s often used when there’s a high risk of recurrence, the extent of the cancer is hard to determine, or the cancer is in a part of the body where appearance or function are high priorities, such as near the eye, the middle of the face, the ears, or the fingers, notes the American Cancer Society (ACS).
Excisional Surgery
This is the go-to treatment for many types of skin cancer, including most melanomas.
As with curettage and Mohs, excisional surgery is typically done in a physician’s office with a local anesthetic.The doctor uses a scalpel to remove the entire tumor, plus a surrounding border of healthy skin as a safety margin.
The physician closes the incision with sutures, then sends the tissue specimen to a laboratory to verify that the border of the healthy skin removed (known as the margin) does not, in fact, contain any cancer cells.
If the lab detects cancer cells in the sample, the patients may need to return to the doctor for additional excision.
Sutures generally stay in place for a week or two until the area heals.
For large tumors that require more extensive surgery, doctors might cover the area with a flap made from skin near the tumor, or from skin taken elsewhere from the body.
Laser Surgery
Doctors may also use laser surgery, in which lesions are vaporized or destroyed with heat, to treat actinic keratoses (squamous cell precancers). Other conditions that may prompt laser surgery include Bowen’s disease (a type of early squamous cell cancer) and very superficial basal cell cancers.
Cryosurgery
This procedure may be used to treat small basal cell or squamous cell carcinoma, or actinic keratosis. The physician applies liquid nitrogen to the growth with a swab or as a spray. Repeating several times if necessary to freeze and kill cells.
The lesion eventually blisters, crust over, and falls off.
Cryotherapy may be the right choice for patients who can’t have more invasive surgery because of bleeding disorders or an intolerance to local anesthetic. But it has a lower overall cure rate than surgical methods.
