“They are very easy [and] low-risk procedures with minimum pain and discomfort.”
What makes skin cancer unique—compared to other types of cancer—is that it begins externally. Unless it spreads beyond the skin, skin cancer can be easily treated with a simple outpatient surgery or procedure. As long as skin cancer is caught and treated early, it can be more easily and effectively treated than most other types of cancers.
“As far as surgeries go, the two most common types of surgical techniques for the non-melanoma skin cancers include a procedure known as Mohs micrographic surgery … or a standard excision,” says Kira Minkis, MD, PhD, dermatologist at Weill Cornell Medicine.
If you’ve been diagnosed with skin cancer—especially a non-melanoma skin cancer or an early-stage melanoma, which are treated similarly—here is what you can expect for the procedure and recovery.
Mohs Micrographic Surgery for Skin Cancer
A Mohs surgery is a newer style of surgery to treat skin cancer. The goal is to reduce the amount of skin removed to improve recovery and post-surgery appearance. Like many procedures for skin cancer, it’s an outpatient procedure—meaning you can go home on the same day after the surgery.
At the dermatologist’s office, you’ll receive local anesthesia to numb the area. The Mohs surgeon will remove a thin sliver of skin with a minimal margin of normal skin around it. “That tissue is then taken to a lab where it is processed, and the Mohs surgeon then serves as a pathologist and evaluates it under the microscope to see whether all the margins are clear, meaning [the cancer] has been completely removed,” says Dr. Minkis.
If the margins are clear, the surgery is over. If the margins are not clear—meaning there are cancer cells in the margin—another thin layer of skin is removed, and this tissue is again evaluated under a microscope. This process continues until the margins are completely clear of cancer cells.
Mohs micrographic surgery is very effective at curing non-melanoma skin cancer while minimizing the amount of skin removed. “However, it is an involved process. There [are] lots of steps involved and because of that, the duration of the procedure is lengthier than for a standard excision,” says Dr. Minkis.
Standard Excision for Skin Cancer
“Standard excision” is essentially a fancy medical term for your typical “under the knife” surgery. The skin cancer growth is removed with a scalpel, along with a margin of around 4 to 5 millimeters of normal skin. Then the area is stitched up immediately, and the removed tissue gets sent to a dermatopathologist for evaluation.
“The pathology is evaluated over the course of about four to seven days or so, so we actually don’t have the results at the time of tumor resection and stitching, as far as whether or not everything has been adequately removed,” says Dr. Minkis.
In other words, there’s a chance that the patient will have to return after the pathology report comes back to have an additional surgery and be stitched up again. While the initial surgery is shorter than a Mohs surgery, it can still be an extended process due to the potential of having to return for additional procedures. On the other hand, there’s also a chance that the surgeon removed more skin than necessary, compared to a Mohs surgery.
Electrodesiccation and Curettage for Skin Cancer
This procedure is more commonly done for the treatment of early-stage, non-melanoma skin cancers on just the top layer of the skin. “It’s a pretty straightforward and quick in-office procedure performed by a dermatologist,” says Dr. Minkis.
Here’s how it works: The dermatologist will numb the skin, and then a sharp instrument (the curette) scrapes off the top layer of skin to remove the cancer cells. Then, an electric needle desiccates, or burns, the base of the area that was scraped.
“That’s generally performed several times in a row … and then the area’s left to heal by itself,” says Dr. Minkis. “It’s a procedure that could be performed with a minimal downtime for the patient, but it does require a wound that then needs to heal for some period of time because it doesn’t require any stitches.”
Recovery: What to Expect
Recovering from a skin cancer surgery is generally less involved than, say, an appendectomy. It essentially comes down to basic wound care:
- Clean the wound regularly
- Keep it moist with antibiotic ointment
- Keep the wound covered with clean bandages
If you have a more advanced melanoma, you will likely need to follow your surgery with adjuvant therapies for melanoma, to ensure all cancer cells are eliminated throughout the body.
“Due to the fact that all of these procedures are in-office procedures performed under local anesthesia, the recovery is usually seamless,” says Dr. Minkis. “The are very easy [and] low-risk procedures with minimum pain and discomfort to the patient, and patients could get back on their feet and back to normal almost immediately afterwards.”
Dr. Minkis is a dermatologist at Weill Cornell Medicine, an assistant professor of dermatology at Weill Cornell Medical College, Cornell University, and an assistant attending dermatologist at NewYork-Presbyterian Hospital.
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The two most common type of surgical techniques
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for the non-melanoma skin cancers include
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a procedure known as Mohs micrographic surgery,
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or Mohs surgery, or a standard excision.
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00:00:19.033 --> 00:00:22.766
Mohs surgery, or Mohs micrographic surgery, is a technique
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for moving skin cancers.
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It's mainly used for the non-melanoma skin cancers,
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most commonly basal cell carcinoma
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and squamous cell carcinoma.
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It's an in-office procedure performed under a local anesthesia,
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whereby the cancer is removed with a minimal margin
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of normal skin around it.
00:00:43.533 --> 00:00:47.799
That tissue is then taken to a lab, where it is processed,
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and the Mohs surgeon then serves as a pathologist
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and evaluates it under the microscope
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to see whether all the margins are clear,
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meaning it's been completely removed.
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The patient is then brought back to the operating room,
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or the procedure room, and an additional margin,
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where it's still necessary, is removed.
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The duration of the procedure is lengthier than for a standard excision.
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A standard excision is a procedure where a skin cancer
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is removed with a standard margin of normal skin around it,
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and typically stitched up immediately afterwards.
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And then that tissue then goes into a bottle of formalin
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which fixes the tissue and is sent to a dermatopathologist
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that then evaluates it microscopically.
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The pathology is evaluated over the course
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of about four to seven days or so.
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If the margin is still involved, the patient then needs
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to come back for a subsequent procedure.
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We need to do a repeat procedure or open up
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and then remove more and restitch.
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These surgeries and procedures are all outpatient procedures,
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which essentially means that the patient is treated
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in an office setting, not in a hospital.
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Generally, it's a one-day procedure.
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The procedure is performed
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and the patient can go home immediately afterwards.
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Aftercare for these procedures really varies,
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depending on the procedure that's performed,
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and depending on the specific case,
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the patient can perform their own wound care
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by just cleaning the wound, keeping it moist with a little ointment
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and keeping it covered.
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Sometimes a more permanent-type bandage is applied
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in the office for about a week.
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Due to the fact that all of these procedures
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are in-office procedures performed under a local anesthesia,
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the recovery is usually seamless.
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The patient, even the evening of the procedure,
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feels well, there's no grogginess.
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They are very easy procedures, low-risk procedures,
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with minimal pain and discomfort to the patient
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and patients could get back on their feet and back to normal
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almost immediately afterwards.
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Skin cancer treatment (PDQR)-patient version. Bethesda, MD: National Cancer Institute. (Accessed on February 27, 2020 at https://www.cancer.gov/types/skin/patient/skin-treatment-pdq.)
Treating basal and squamous cell skin cancer. Atlanta, GA: American Cancer Society. (Accessed on February 27, 2020 at https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/treating.html.)
Treatment and prognosis of basal cell carcinoma at low risk of recurrence. Waltham, MA: UpToDate, 2020. (Accessed on February 27, 2020 at https://www.uptodate.com/contents/treatment-and-prognosis-of-basal-cell-carcinoma-at-low-risk-of-recurrence.)
Treatment and prognosis of low-risk cutaneous squamous cell carcinoma. Waltham, MA: UpToDate, 2020. (Accessed on February 27, 2020 at https://www.uptodate.com/contents/treatment-and-prognosis-of-low-risk-cutaneous-squamous-cell-carcinoma.)
What are basal and squamous cell skin cancers? Atlanta, GA: American Cancer Society. (Accessed on February 27, 2020 at https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/what-is-basal-and-squamous-cell.html.)