Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapy—energy beams that penetrate the skin, killing cancer cells in the body.
Basal cell cancer is less likely to become aggressive, but if it does, our physicians may use surgery and other therapies to treat it.
Electrodessication and Curettage
During electrodessication and curettage, an outpatient procedure, doctors numb the skin using a local anesthetic and scrape off cancer cells with a tool called a curette, a small scoop that has sharp edges. They then apply electricity with a probe to stop any bleeding. This process is repeated several times. Afterward, doctors place a bandage on the treated area. The treatment may leave a small, raised, pink or white scar.
This procedure can be used for small basal cell or squamous cell cancers that have not spread beyond the top layer of skin and those that are not close to sensitive areas, such as the eyes or lips.
The simple and quick procedure helps people avoid surgery, but the destroyed tissue does not get sent to a pathologist for examination. That means you won’t know for sure if all the cancer cells were removed.
Standard Surgical Excision
During a standard surgical excision, a doctor removes the entire tumor with a border of healthy tissue. He or she closes the incision with stitches, and the tissue is sent to a laboratory, where a dermatopathologist examines it under a microscope to confirm that the entire tumor has been removed. Test results may take anywhere from several days to a week.
Surgical excision is usually performed using a local anesthetic. People who undergo this approach can usually go home the same day of the procedure. They may experience some discomfort for a few days. Stitches are usually removed 7 to 14 days later.
During Mohs surgery, the surgeon removes the skin cancer, along with a very small border of healthy tissue. Mohs surgeons are fellowship-trained doctors with special expertise in skin cancer removal and surgical reconstruction after removal of skin cancer. The American College of Mohs Surgery grants membership to fellowship-trained Mohs surgeons who have fulfilled rigorous requirements regarding training and managing complex skin cancers.
Local anesthesia is usually used for this procedure. After the area is numb, the surgeon removes a thin layer of tissue. Then, a nurse may bandage you and have you sit in a waiting room while your doctor examines the tumor and a surrounding border, or margin, of tissue to ensure that there are no remaining cancer cells. If any cancer cells remain in the margin, the surgeon removes another thin layer of tissue and examines it to make sure the cancer has been removed completely.
Mohs surgery is extremely effective and leaves the smallest possible scar.
Our doctors may use Mohs surgery to remove a large or rapidly growing skin cancer or one that has returned. It may also be used for a cancer located in scar tissue or on an area of the body that requires good cosmetic results, such as the ears or face.
Mohs surgery allows surgeons to keep the borders of healthy tissue small, minimizing scarring. The approach also allows doctors to evaluate 100 percent of the tissue margin, compared with 2 to 3 percent in standard surgical excision.
Mohs surgery also reduces the need for additional surgery. You can usually go home the same day of the procedure. Because of waiting time for pathology results and the possibility of more than one round of surgery, the entire procedure can take several hours.
Lymph Node Biopsy
If the cancer has spread to area nerves or blood vessels, the doctor may recommend that you undergo a lymph node dissection, the surgical removal of one or several area nodes. A pathologist examines the tissue under a microscope to see if it contains cancer.
If a doctor feels a swollen lymph node under the skin near the site of the cancer, he or she may obtain a sample of it with a needle biopsy. With this type of biopsy, a doctor inserts a needle into the lymph node to extract a small tissue sample and determine if it contains cancer before removing it.
Knowing whether lymph nodes are cancerous can help doctors decide what other treatment you might need after surgery, including medication or radiation therapy.
Doctors can use stitches to close small incisions, but large ones may need to be repaired using reconstructive procedures.
Reconstruction can be performed the same day as Mohs surgery because doctors can immediately confirm whether the entire tumor has been removed. For standard surgical excision, reconstruction is delayed until pathologists can verify the borders are cancer free. In most cases, reconstruction is performed by the Mohs surgeon under local anesthesia.
The surgical approach depends on the tumor location and how much surrounding tissue was removed. For an area of skin that isn’t too deep, doctors may use a skin graft, or a small portion of the top layers of healthy skin. It’s usually taken from an area of your body where missing skin wouldn’t be noticeable, such as the inner thigh.
To fill in and close a larger or deeper opening of the skin, doctors may use a local flap, or a piece of nearby skin, which can include underlying fat and muscle. It is moved while it’s still attached to its current blood supply. Cartilage, the firm, white tissue that helps give structure to parts of the body such as the ears and nose, may also need to be moved during reconstruction.
Skin flaps are often left in place for several weeks as the surgical site heals. In a second surgery, they are contoured to match the appearance of the surrounding healthy skin and tissues. For example, areas of the nose can be repaired with a local skin flap from the cheek and cartilage from the ear. Doctors perform another surgery to remove any extra flap tissue and carefully reconstruct the shape of the nose with minimal scarring to the face.
Sometimes, if a large skin cancer needs to be removed, doctors may use free flaps of skin, fat, or muscle from a distant part of the body, such as the back or abdomen, to fill in areas where the cancer has been removed. These tissue flaps are called “free” because they are detached from their blood supply. Blood vessels are reattached at the site of repair.
After surgery, our physicians help scars heal properly. For example, they can carefully tape incisions after surgery and leave this tape in place for several days, to prevent scarring. If a scar becomes raised or red, doctors can inject the area with steroids, which helps flatten the tissue and remove the redness. Lasers can also treat discoloration.
Recovery time from basal and squamous cell cancer surgery varies, depending on the size of the tumor, whether lymph nodes were removed, and whether you undergo reconstruction.
Our doctors closely monitor you after surgery to ensure you are healing properly and to manage any discomfort, whether with medications or with our integrative health therapies.
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