Excision is often the sole treatment for both melanoma and non-melanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma.
Surgical Excision of Non-Melanoma Skin Cancers
Surgical excision is the standard treatment for basal cell and squamous cell carcinomas with a very high cure rate. Depending on the size, location and type of lesion, the excision may be performed in a dermatology clinic under local anesthesia or may be referred for Mohs micrographic surgery. Larger and more extensive skin cancers may be treated in the hospital under general anesthesia. However, when caught early, most skin cancers are easily treatable in the clinic with little to no down-time after the procedure.
The goal of excision is to remove the entire skin cancer to prevent further extension into surrounding tissues. Extra tissue around the affected area is also removed to ensure surrounding margins are cancer-free.
Upon removal, the specimen is sent to the lab and reviewed under a microscope. If the margins are clear, it is an indication that the skin cancer has been successfully excised. If the margins are not clear, additional surgery may be required. Occasionally, radiation therapy may be used in addition to excision or Mohs surgery to prevent reoccurrence of the cancer (often for larger or more advanced cancers).
Excision of Melanoma Skin Cancer
The simple excision technique used for melanoma is often curative in early stage melanoma. Treatment of melanoma depends mainly on the thickness of the tumor and how deep it penetrates into the skin. Depending on the thickness, wider margins may be needed to ensure the cancer is completely removed. This technique is known as wide local excision. Larger excisions may require a skin graft for closing.
Location of the melanoma may also help in determining margin size. When possible, smaller margins may be used to reduce scarring on the face or other more visible sites.
Wide surgical excision with lymph node biopsy may be needed in cases where a melanoma is deeper or more advanced. Depending on the size, depth and location of the lesion, your physician can discuss the appropriate treatment option.
Skin Cancer Excision versus Mohs Micrographic Surgery
With local excision, the entire cancer is removed along with some of the surrounding healthy tissue at one time in order to assure clear margins. Depending on the type, size and location of the cancer, different margins may be taken to assure proper treatment. This is often the appropriate treatment option for most skin cancers on the trunk and extremities, or smaller cancers on the face. Treatment is usually is done in the clinic under local anesthesia with usually excellent recovery and almost no down time.
Mohs microcgraphic surgery is a tissue-sparing procedure in which the tumor is excised in layers and mapped out. It is often an appropriate treatment option for larger skin cancers with ill-defined borders or cancers on cosmetically sensitive areas such as the nose or near the eyes or lips. Each layer is examined microscopically so that only layers containing cancer cells are removed, leaving healthy skin intact. This procedure is usually done in a clinical setting, although larger cancers may be treated in the hospital. Depending on the size and location of the cancer, the resulting wound may be repaired by either a primary closure in which the wound margins are closed and stitched, a skin graft, or a skin flap.
If you are diagnosed with a skin cancer, talk with your dermatologist about what treatment option is best for you.