Types of surgery used to treat nonmelanoma skin cancer

Mohs surgery

This procedure removes the cancer and as little normal tissue as possible. It’s done in sensitive areas such as the face. During Mohs surgery, you’re given a local anesthetic to numb the area being treated. The cancer is removed from the skin one layer at a time. Each layer is checked under a microscope for cancer. If cancer cells are seen, another layer of skin is removed. Layers are removed until the healthcare provider doesn’t see any more cancer. The procedure is done at one time, but it may take several hours, depending on how many layers need to be removed. After this surgery, the cancer is fully removed and the wound can be repaired. Mohs surgery may be a good option if:

• Your doctor is not sure of the exact depth and shape of the tumor

• The tumor is very large

• The tumor is located in a hard-to-treat place

• The skin cancer has come back

• The skin cancer is on the face

Curettage and electrodesiccation

This procedure removes tissue and cauterizes the area. You are given a local anesthetic to numb the area. Your healthcare provider then uses a sharp, spoon-shaped instrument called a curette to remove the cancer. This is called curettage. After curettage, your healthcare provider passes an electric needle over the surface of the scraped area to stop bleeding and destroy any remaining cancer cells. After it heals, a flat, white scar may remain.

Simple excision

This is done to cut the cancer from the skin, along with some of the healthy tissue around it. You are given a local anesthetic. Then your healthcare provider uses a scalpel to remove the tumor from the skin. The healthcare provider may also remove some of the normal skin around the tumor. This is called a margin. Depending on the size of the cut (incision), stitches or a sterile bandage strip may be used to close the wound. The tissue that was removed is sent to a lab for testing. If testing shows that not all the cancer was removed, you’ll likely need another procedure to remove the rest of the cancer.

Shave excision

This method is used for cancer that is only in the top layers of the skin. You are given a local anesthetic. Then, your healthcare provider uses a small blade to shave off the tumor. The goal is to remove the tumor.

Cryosurgery

This method uses cold to destroy the cancer cells. This method is best for very small cancers near the skin’s surface. Your healthcare provider uses a device that sprays liquid nitrogen onto the tumor. This freezes the cells and destroys them. The dead skin then falls off. You may have some swelling and blistering in the area after treatment. A white scar is usually left behind. The procedure may need to be repeated.

Laser treatment or dermabrasion

Laser therapy uses a narrow beam of intense light to remove cancer cells. Dermabrasion removes the top layer of skin with a rotating wheel or small particles that rub away skin cells. These types of surgery are not as common. It’s not possible to see if all the cancer cells were removed with these methods. These kinds of surgery also don’t produce a tissue sample that can be checked for cancer cells.

What to expect after surgery

It will take a couple of weeks for your skin to heal. During this time, you may have:

• Bruising

• Minor pain

• Redness and swelling at the site

• Risk for infection

• Scarring

Talk with your healthcare team about what to expect.

Pain after surgery

Short-term (temporary) pain in the area of the surgery is a common side effect. You may feel pain in the first few days to a week after surgery. You can treat pain with pain medicine as your healthcare provider advises. Use only approved pain medicine.

Scarring after surgery

Any skin surgery leaves scars. The same is true for surgery to remove skin cancer. The size and color of the scar depend on the size of the cancer, its location, the type of surgery, and how well your skin heals. Your healthcare provider will use methods to hide the scar as much as possible.

If stitches were used to hold the wound closed, they are usually removed about a week or 2 after surgery. Healing continues over time after that. Early on, the scar may be red or bumpy. It takes about a full year for a scar to fade. Be sure to speak with your healthcare provider about ways to aid healing. Most often, though, your body's natural healing abilities are the best. It may just take some time.

Working with your healthcare provider

Talk with your healthcare provider about what kind of surgery is best for you. Ask any questions and address any concerns you may have.