MED0001860545
Read more here This website contains imagery which is only suitable for audiences 18+. All surgery contains risks.
This website contains imagery which is only suitable for audiences 18+. All surgery contains risks.
MED0001860545: This website contains imagery which is only suitable for audiences 18+. All surgery contains risks.
Read more here
Skin cancer surgery involves the excision of a skin cancer along with a margin of surrounding tissue, and reconstruction of the resulting defect. Many skin cancers are simple to remove and close directly, with the resulting scar sitting within a small excision line.
At a Glance
Skin Cancer Surgery
Introduction
Skin cancer surgery involves the excision of a skin cancer along with a margin of surrounding tissue, and reconstruction of the resulting defect. Many skin cancers are simple to remove and close directly, with the resulting scar sitting within a small excision line. Cancers in visible areas of the face, cancers that are larger or deeper, and cancers where wider margins are needed for oncological reasons often require more complex reconstruction using local tissue rearrangement, skin grafts, or other techniques.
The role of plastic surgery in skin cancer treatment is typically the excision itself where wider margins or a technically demanding reconstruction is needed, and the reconstruction of defects following excision by others (including following Mohs surgery performed by dermatologists). Referrals commonly come from dermatologists, general practitioners, or other treating clinicians after a biopsy or diagnosis has been made. The information on this page is a general overview. The specific approach for any individual patient depends on the type of skin cancer, its location, and the specifics of the case.
Types of skin cancer commonly treated
The three most common skin cancers treated with surgery are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Each has its own characteristics, its own recommended margins of excision, and its own considerations for reconstruction.
The most common skin cancer. BCCs typically grow slowly and rarely spread to other parts of the body, but they can be locally destructive if left untreated. Surgical excision is one of the standard treatments, with the specific margins based on the size, subtype and location of the cancer.
The second most common skin cancer. SCCs can spread to other parts of the body in some cases, particularly when they’re larger, deeper, or in higher-risk locations. Surgical excision with appropriate margins is a standard treatment, sometimes combined with other treatments where indicated.
A less common but potentially more serious skin cancer. Surgical excision with margins based on the depth of the melanoma is the standard treatment for primary melanoma, and further procedures (including sentinel lymph node biopsy) may be indicated in some cases. Treatment of melanoma often involves a multidisciplinary team, and plastic surgery may be part of this where wider excisions or reconstruction of the resulting defect are needed.
Other, less common skin cancers can also be treated surgically. The specific approach depends on the diagnosis and is worked through with the referring specialist and the wider treating team.
Excision principles
The core principle of skin cancer surgery is complete excision of the cancer with an appropriate margin of surrounding tissue. The margin varies with the type of cancer, its size, its subtype, its location, and other factors, and the specific margin used in any individual case is based on evidence-based guidelines for that cancer type.
After excision, the removed tissue is sent for pathology to confirm that the cancer has been completely removed and to assess the margins. Where the pathology confirms complete excision, the initial operation may be all that’s needed. Where the pathology shows that the cancer extends to the margins of the excision (incomplete excision), further surgery may be needed to remove residual cancer.
Some skin cancers, particularly on the face, are treated with a technique called Mohs micrographic surgery, performed by a specialised dermatologist. In Mohs surgery, the cancer is removed in stages with each stage examined under the microscope during the operation, so that the smallest possible amount of surrounding tissue is removed while ensuring complete excision. Where Mohs surgery has been performed and the resulting defect requires reconstruction beyond direct closure, plastic surgery may be involved in the reconstruction stage. This is a common referral pathway for facial skin cancer defects.
Reconstruction approaches
The reconstruction of a defect after skin cancer excision depends on the size and location of the defect, the surrounding tissue, and functional considerations. Several approaches are used, sometimes in combination.
The simplest approach, where the edges of the defect are brought together and closed directly. This works well for small defects in areas with reasonable skin laxity. The resulting scar is a straight line, ideally aligned with natural skin creases where possible.
Where the defect is too large for primary closure but there’s available tissue nearby, a local flap can be used to fill the defect. The flap is a piece of skin and underlying tissue that’s rotated, advanced or transposed from an adjacent area to cover the defect. The blood supply to the flap is maintained through its attachment to the surrounding tissue. Local flaps are commonly used on the face, where the specific flap chosen is designed to sit within the natural aesthetic units of the face to produce the best possible cosmetic result.
When a flap isn’t appropriate or the defect is very large, a skin graft can be used. A thin layer of skin is taken from another part of the body (the donor site) and transferred to cover the defect. The graft heals into place over the following days and weeks by developing a new blood supply from the underlying tissue. Skin grafts produce a different appearance from the surrounding skin, which is an important consideration when they’re used in visible areas.
For very large or complex defects, a free flap may be used, where a piece of tissue is transferred from another part of the body with its blood supply reconnected using microsurgical techniques. This is used in specific situations where simpler techniques wouldn’t be adequate for the reconstruction.
Face reconstruction
The face is a common site for skin cancer, and reconstruction of facial defects is a particular focus of plastic surgery in this context. The face is divided into aesthetic units (forehead, cheek, nose, lip, chin and other regions) that share consistent qualities of skin colour, texture and thickness. Reconstructing within aesthetic units, or replacing a whole unit rather than part of one, generally produces a better cosmetic result than reconstruction that crosses unit boundaries.
The nose is a specific area where reconstruction after skin cancer can be technically demanding, because the nose has a complex three-dimensional shape and the skin varies significantly across different parts. Reconstruction of nasal defects may involve local flaps from the cheek or forehead, cartilage grafts to restore support, and staged procedures to refine the result.
Facial reconstruction after skin cancer surgery is typically performed in an accredited hospital, sometimes under general anaesthesia and sometimes under local anaesthesia with sedation, depending on the size and complexity of the reconstruction.
The procedure
Skin cancer surgery can be performed under local anaesthesia, local anaesthesia with sedation, or general anaesthesia, depending on the size and complexity of the operation and the specifics of the case. Simpler excisions and reconstructions are often performed under local anaesthesia as a day procedure. Larger or more complex operations may require general anaesthesia and an inpatient stay.
The tissue removed at surgery is sent for pathology. Results typically take several days to a week. A follow-up appointment is arranged to review the pathology, check the wound, and remove sutures where appropriate. Where the pathology shows incomplete excision, further surgery may be recommended.
Recovery
Recovery depends on the size and location of the operation. Small excisions and primary closures heal quickly, with sutures typically removed within one to two weeks and most patients back to normal activity soon after. Larger reconstructions with local flaps or skin grafts have longer recovery periods, with restrictions on activity while the flap or graft heals.
Facial skin cancer surgery often involves visible dressings for the first days after the procedure, with the dressing changed at the first follow-up appointment. Bruising and swelling are expected around the operative site and settle over one to two weeks. Sutures are typically removed within one to two weeks depending on the location. Sun protection over the operated area is important during healing and long term.
Larger operations, particularly involving flaps or grafts, may require restricted activity for several weeks to allow the reconstruction to heal without disturbance. Vigorous exercise and any activity that could disturb the operated area is avoided during this time.
Risks
The recognised risks include:
Medicare
Skin cancer excision and reconstruction is generally covered by Medicare, with the specific rebates depending on the type of cancer, the size and location of the excision, and the reconstruction technique used. Private health insurance also generally covers skin cancer surgery at Medicare-eligible levels for procedures requiring hospital admission. A written quote is provided at consultation covering all costs, including any gap between Medicare and private rebates and our fees.
Results vary
Honest counsel on outcomes
Final appearance, scar appearance, and functional outcome depend on the size and location of the excision, the reconstruction technique used, the underlying skin quality, and individual healing characteristics. The oncological outcome depends on the complete excision of the cancer and follow-up surveillance. There’s no guaranteed cosmetic result, and follow-up assessment of the operated area and other skin areas continues as recommended by the treating clinicians.
FAQs
Yes. A referral is required, typically from a dermatologist, general practitioner or other treating clinician who has made or investigated the diagnosis. The referral usually includes information about the biopsy result and the treating team’s recommendations.
It depends on the size and complexity. Small excisions closed directly typically heal within one to two weeks, with sutures removed at that point. Larger reconstructions with flaps or grafts take longer, sometimes several weeks. The final scar continues to mature over 12 to 18 months.
Recurrence depends on the type of cancer, its features, and whether the excision was complete. Complete excision significantly reduces but doesn’t eliminate the risk of recurrence, and follow-up surveillance is part of the ongoing care. Development of new skin cancers in other sun-damaged areas is a separate concern and is typically followed by a dermatologist or GP.
Yes. Some scarring is unavoidable after any excision. The specific pattern and visibility depends on the size, location, and reconstruction technique. On the face, reconstruction is planned to place scars within natural skin creases and aesthetic unit boundaries where possible. Scars mature over 12 to 18 months, and their final appearance is influenced by individual healing characteristics.
Generally yes. Skin cancer excision and reconstruction is covered by Medicare, with the specific rebates depending on the procedure. Private health insurance also generally covers procedures requiring hospital admission. A written quote is provided at consultation.
Where pathology shows that the cancer extends to the margins of the excision, further surgery is generally recommended to remove any residual cancer. This is discussed at the follow-up appointment when the pathology is reviewed. Further surgery may involve re-excision of the area, sometimes with a larger reconstruction than the initial procedure.
Practitioner
Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545