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).
This is similar to an excisional biopsy, but in this case the diagnosis is already known. For this procedure, the skin is first numbed with a local anesthetic. The abnormality is then removed with a surgical blade, along with some of the surrounding 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 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.
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, Dr. O’Brien removes a very thin layer of the skin (including the abnormality) 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.
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 incision 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.