Surgery & Other Procedures
A number of procedures are used to treat skin cancer and precancer. Treatment depends on the cancer type, location, and stage. The cancer stage is a way of describing how extensive a cancer is. Skin cancer is diagnosed by biopsy. After the diagnosis, your doctor may do additional tests to stage the cancer. Once the cancer is staged, you can discuss treatment options.
Treatment procedures for skin cancer and precancer
Primary Treatments:Excision, Mohs surgery
Alternatives to Surgery:Cryotherapy (precancer and low-risk skin cancer), curettage and electrodesiccation (precancer and low-risk skin cancer), radiation therapy
Additional Treatment for Advanced or High-Risk Cancer:Lymph node dissection (removal), adjuvant radiation therapy
Treatment for Precancer (actinic keratosis):Photodynamic therapy, laser surgery, chemical peel
Palliative Therapy: Radiation therapy
Follow-Up Surgery:Skin grafting and reconstructive surgery
Early-stage skin cancer: surgery
Non-melanoma skin cancer and early-stage melanoma can usually be treated by surgery alone.1,2
Surgical excision is the first choice for treating many skin cancers. Excision means “cut out.” The doctor cuts the tumor out, along with a margin of healthy tissue. The reason for taking a margin is to remove any cancer cells that have spread into the surrounding tissue. When possible, the excision is done in elliptical (football) shape. This type of cut is easily stitched together.3 The resulting scar looks like a thin line.4
Mohs surgery is an alternative to excision. Mohs surgery is most often used to remove basal cell carcinoma or squamous cell carcinoma. Occasionally, it may be used to treat melanomas. Mohs surgery is done by removing one layer of skin at a time. The surgeon checks each layer under a microscope for cancer cells. The surgeon removes tissue layer by layer until the margins are clear.
Skin cancers frequently develop on the face. It may be important to minimize scarring. Sometimes surgery leaves a large wound (defect). A skin flap or graft repair can be done to close large wounds and minimize scarring.
Alternatives to surgery
Radiation therapy can be an alternative to surgery. It may be a primary (main) treatment for large tumors. It is also used to treat tumors in delicate locations.
Other alternatives to surgery for some non-melanoma skin cancers are:
- Curettage and electrodesiccation
- Laser surgery
Curettage and electrodesiccation treats tumors by scraping away the cancerous tissue and destroying remaining cancer cells with an electric needle. Cryotherapy is when liquid nitrogen is used to destroy a lesion. Laser surgery vaporizes the top layers of skin. Laser surgery can treat thin cancerous lesions.5,6
Advanced or high-risk skin cancer: treatment procedures
Lymph node dissection (removal) treats cancer that has spread to the lymph nodes. One possible benefit is less lymph node pain.2 A possible risk of this surgery is lymphedema. Lymphedema is when fluid builds up in the limbs. Lymph nodes normally drain the fluid, so removing them can lead to lymphedema.
Radiation therapy can be a second (adjuvant) therapy for high-risk skin cancer. Adjuvant therapy is used after a primary treatment, such as surgery. The goal is to kill remaining cancer cells and reduce the chance of recurrence.1,7
Actinic keratosis (precancer)
Your doctor may recommend removing actinic keratoses. Actinic keratosis is an abnormality that can lead to squamous cell carcinoma. Actinic keratoses can be removed with topical medications or through a number of procedures. Cryotherapy is the most common procedure for treating actinic keratosis.8 Curettage, photodynamic therapy, chemical peeling, and laser surgery are other procedures sometimes used to remove actinic keratoses.