Skin Cancer Surgery / Melanoma Surgery

Introduction

If you or someone close to you has been diagnosed with skin cancer, surgery is likely to be the central part of treatment. For most skin cancers including the common non-melanoma types and the more serious melanoma — surgical removal offers the best chance of clearing the disease completely. The good news is that when skin cancer is found and treated early, the outlook is generally very favourable.

This guide is written for people who already have a skin cancer diagnosis and are planning the next steps. It explains the different types of skin cancer surgery, how doctors decide which approach to use, what happens before, during, and after the operation, and what recovery and long-term follow-up look like. It also covers the related procedures — such as sentinel lymph node biopsy and lymph node dissection — that may be part of melanoma treatment.

Skin cancer surgery ranges from a small in-office procedure under local anaesthetic to a larger operation involving wider tissue removal, reconstruction, and lymph node sampling. Understanding which category your treatment falls into can help you prepare practically and emotionally for the weeks ahead.

What Is Skin Cancer Surgery?

Skin cancer surgery is the surgical removal of cancerous or precancerous growths from the skin, along with a margin of healthy-looking tissue around them. The aim is to remove all the cancer cells, including any microscopic spread that may not be visible to the naked eye, while preserving as much normal skin and function as possible.

The three most common types of skin cancer treated surgically are:

• Basal cell carcinoma (BCC): the most common form of skin cancer. It grows slowly, rarely spreads to other parts of the body, but can cause significant local damage if left untreated.
• Squamous cell carcinoma (SCC): the second most common form. It can grow more quickly than BCC and has a higher (though still low) chance of spreading.
• Melanoma: a less common but more serious skin cancer that develops from pigment-producing cells called melanocytes. Melanoma can spread to lymph nodes and distant organs if not treated early.

Less common skin cancers — such as Merkel cell carcinoma, cutaneous lymphomas, and skin adnexal tumours — are also treated surgically, often with approaches similar to those used for melanoma.

Surgery may be the only treatment needed, particularly for small, early cancers. For more advanced disease, surgery is usually combined with other treatments such as radiation therapy, targeted therapy, or immunotherapy, planned by a multidisciplinary team.

Why Is Skin Cancer Surgery Performed?

The main goals of skin cancer surgery are to:

• Remove the cancer completely, with clear margins (no cancer cells at the edges of the removed tissue)
• Confirm the diagnosis and stage through laboratory examination of the removed tissue
• Determine whether the cancer has spread to nearby lymph nodes, when relevant
• Reduce the risk of the cancer returning at the same site
• Preserve function and appearance, particularly when the cancer is on the face, hands, or other visible or functionally important areas

For non-melanoma skin cancers caught early, surgery alone has a high cure rate. For melanoma, the depth of the tumour at the time of surgery is one of the strongest predictors of long-term outcome, which is why early surgical removal is so important.

Who Is a Candidate?

Most people with a confirmed skin cancer diagnosis are candidates for surgery. The decision about which type of surgery, and whether additional treatments are needed, depends on several factors:

• The type of skin cancer: basal cell, squamous cell, melanoma, or a rarer subtype
• The size and depth of the tumour: measured by the dermatologist or pathologist after biopsy
• The location: cancers on the face, ears, lips, fingers, and genitals often need more precise techniques to spare healthy tissue
• The stage: whether the cancer is confined to the skin or has spread to lymph nodes or distant sites
• Features under the microscope: such as how aggressive the cancer cells look, whether they have invaded nerves or blood vessels, and ulceration in melanoma
• Your overall health: age, other medical conditions, ability to tolerate anaesthesia, and bleeding risk
• Prior treatment: whether the cancer is new or has come back after previous treatment

For people who are not well enough to tolerate surgery, or whose cancers are in places where surgery would cause unacceptable loss of function or appearance, non-surgical options such as radiation therapy or topical treatments may be considered. These decisions are usually made in discussion with a multidisciplinary team that includes dermatologists, surgical oncologists, medical oncologists, radiation oncologists, and reconstructive surgeons.

Alternatives to Surgery

Surgery is the standard of care for most skin cancers, but other treatments do exist and may be used either as alternatives or as additions to surgery.

For non-melanoma skin cancers

Curettage and electrodessication: the lesion is scraped away with a curette and the base is cauterised. This is used for small, superficial basal cell carcinomas and some squamous cell carcinomas in low-risk areas.

Cryotherapy: freezing the cancer with liquid nitrogen. This may be used for superficial cancers and precancerous lesions called actinic keratoses.

Topical treatments: creams such as imiquimod or 5-fluorouracil applied to the skin over several weeks. These are options for some superficial basal cell carcinomas and precancerous lesions.

Photodynamic therapy (PDT): a light-sensitising medication is applied to the skin and then activated with a special light, destroying the abnormal cells.

Radiation therapy: used when surgery is not possible, when the cancer is in a location where surgery would cause significant disfigurement, or after surgery when the margins are not clear.

Targeted drug therapy: for advanced basal cell carcinomas that cannot be removed surgically, oral medications that block specific molecular signals are sometimes used.

For melanoma

For early melanoma, surgery is the primary treatment and alternatives are limited. For advanced or metastatic melanoma, modern immunotherapy and targeted therapies (for melanomas with specific genetic changes such as BRAF mutations) have substantially changed outcomes. These treatments are often combined with surgery rather than replacing it.

Whether any of these alternatives is appropriate is a clinical decision based on the cancer type, location, and your overall situation.

Types of Skin Cancer Surgery

Several different surgical techniques are used, depending on the cancer type, size, location, and depth. Most patients will undergo one of the following.

Simple (standard) surgical excision

This is the most common technique for many skin cancers. The surgeon uses a scalpel to cut out the cancer along with a margin of healthy-looking skin around it. The size of the margin depends on the type and size of the cancer:

• For most basal cell carcinomas: a margin of about 4 mm is typical
• For squamous cell carcinomas: 4 to 6 mm or more, depending on risk features
• For melanoma: margins are based on the tumour thickness (see “Wide local excision” below)

The removed tissue is sent to a laboratory, where a pathologist examines the edges (margins) under the microscope to check that no cancer cells reach the cut surface. The wound is usually closed with stitches. Results from the laboratory typically take several days to a couple of weeks.

If the pathology report shows that cancer cells extend to the margin (called a positive margin), further surgery is usually needed to remove the remaining tissue.

Mohs micrographic surgery

Mohs surgery is a specialised technique used for skin cancers in cosmetically or functionally sensitive areas (such as the face, ears, fingers, and genitals), for large or recurrent cancers, and for certain aggressive subtypes. It is most commonly used for basal cell and squamous cell carcinomas, and in some centres for early melanoma in specific locations.

The technique works as follows:

1. The visible cancer is removed in a thin layer.
2. While the patient waits, the surgeon (who is also trained as a pathologist for this purpose) examines the entire underside and edges of the removed tissue under a microscope.
3. If any cancer cells are found at the edges, the surgeon goes back and removes another thin layer only from the area where cancer was seen.
4. The process is repeated, layer by layer, until no cancer cells are seen at any of the margins.
5. Once the cancer is fully removed, the wound is repaired — either by direct closure, a skin graft, or a flap reconstruction.

Wide local excision (for melanoma)

Wide local excision is the standard surgical treatment for melanoma confined to the skin. After the initial biopsy confirms melanoma and measures its thickness (called the Breslow depth), the surgeon removes a wider area of skin around the original biopsy site. The width of the margin is based on the melanoma's thickness, following current professional guidelines:

• For melanoma in situ (very superficial): about 0.5 to 1 cm
• For melanoma less than 1 mm thick: about 1 cm
• For melanoma 1 to 2 mm thick: 1 to 2 cm
• For melanoma more than 2 mm thick: 2 cm

The excision extends down to the layer of fat beneath the skin and, in some cases, to the muscle covering (fascia). Closure may be done with stitches, a skin graft, or a flap, depending on the size and location.

Sentinel lymph node biopsy

For melanomas above a certain thickness (typically more than 0.8 mm, or thinner melanomas with high-risk features), doctors may recommend a sentinel lymph node biopsy at the same time as the wide local excision. This procedure checks whether melanoma cells have spread to the first lymph nodes draining the area of the skin.

The procedure works by injecting a small amount of a radioactive tracer and/or a blue dye near the original melanoma site. These substances travel along the lymph vessels to the first (“sentinel”) lymph nodes. The surgeon then makes a small incision in the relevant lymph node basin (usually the armpit, groin, or neck) and removes only those sentinel nodes for laboratory examination.

The result helps decide:

• The stage of the melanoma
• Whether additional treatments such as immunotherapy or targeted therapy are likely to be useful
• The intensity of follow-up

If the sentinel node contains melanoma cells, current guidelines no longer routinely recommend removing all the lymph nodes in that region (called a complete lymph node dissection). Instead, careful monitoring with ultrasound scans and discussion of systemic therapy is often preferred. This change in practice has been driven by large trials showing that complete lymph node dissection in this setting did not improve survival and increased the risk of complications.

Lymph node dissection (lymphadenectomy)

When lymph nodes are clearly involved by cancer — for example, when they can be felt during examination or are visible on imaging — surgery to remove the lymph nodes in that region (axillary, groin, or neck dissection) may be recommended. This is a larger operation with a longer recovery and a meaningful risk of lymphoedema (swelling caused by impaired lymph drainage) in the affected limb.

Reconstructive surgery

When the area removed is large or in a visible or functional location, the wound may need more than simple stitches. Reconstructive options include:

• Skin graft: a piece of skin taken from another part of the body and placed over the wound
• Local flap: nearby skin and tissue is rotated or moved to cover the defect, preserving the original blood supply
• More complex reconstruction: for larger defects, particularly on the face, plastic surgeons may use staged or multi-step techniques

Reconstruction is sometimes done at the same time as cancer removal, and sometimes delayed until the final pathology confirms clear margins.

Preparing for Skin Cancer Surgery

Preparation depends on the size and complexity of the operation. For a small in-office excision under local anaesthetic, preparation is minimal. For larger procedures involving general anaesthesia, sentinel lymph node biopsy, or reconstruction, more steps are involved.

Before the procedure

Your team will usually:

• Confirm the diagnosis and stage, sometimes with additional imaging such as ultrasound, CT, MRI, or PET scans for thicker melanomas or known nodal involvement
• Review your medical history and medications, including blood thinners, herbal supplements, and over-the-counter painkillers that can affect bleeding
• Order pre-surgery blood tests and, where needed, heart and lung assessments
• Explain the planned operation, the expected scar location and size, and any reconstruction options
• Discuss anaesthesia — local, regional, sedation, or general — depending on the procedure

Practical preparation

• Arrange transport home, especially if you will receive sedation or general anaesthesia
• Plan for time off work and help at home if the surgery is on a hand, foot, or other area that limits movement
• Wear loose, easy-to-remove clothing on the day of surgery
• Follow fasting instructions if you are having sedation or general anaesthesia
• Stop or adjust medications only as advised by your doctor — do not stop blood thinners without instruction
• Take photographs of the area beforehand if you want a record of how the skin looked before surgery

If you smoke, your team may encourage you to stop or reduce smoking before surgery, particularly if a skin graft or flap is planned. Smoking significantly impairs wound healing.

What Happens During the Procedure

The exact steps depend on the type of surgery, but most skin cancer operations follow a similar overall pattern.

Small in-office excision

For a simple excision under local anaesthetic:

1. The area is cleaned and marked with a surgical pen, showing the planned margin.
2. Local anaesthetic is injected. You may feel a brief sting, then numbness.
3. The surgeon removes the lesion with a scalpel, often in an elliptical (eye-shaped) cut to allow the wound to close neatly.
4. Bleeding is controlled with cautery or pressure.
5. The wound is closed with stitches — often two layers (deep dissolving stitches and surface stitches).
6. A dressing is applied and instructions for wound care are given.

The whole appointment usually takes 30 to 60 minutes.

Mohs surgery

Mohs surgery is performed under local anaesthetic and involves cycles of tissue removal and microscopic examination. You will spend most of the day at the clinic, with waiting periods between each stage. Once the cancer is fully cleared, reconstruction is performed the same day.

Wide local excision with sentinel lymph node biopsy

For melanoma surgery combining wide local excision and sentinel lymph node biopsy:

1. Earlier in the day, a small amount of a radioactive tracer is injected near the melanoma site. A scan (lymphoscintigraphy) maps which lymph nodes the tracer drains to.
2. In the operating theatre, you receive general anaesthesia or, in some cases, regional anaesthesia with sedation.
3. Blue dye is often injected near the melanoma site to help visually identify the sentinel nodes.
4. The surgeon makes a small incision over the lymph node basin and uses a handheld probe to locate the sentinel nodes, which are then removed.
5. The surgeon then performs the wide local excision at the original melanoma site.
6. The wound is closed, sometimes with a skin graft or flap if the defect is large.

The operation usually takes one to three hours, depending on complexity.

Lymph node dissection

A lymphadenectomy is performed under general anaesthesia. The surgeon makes an incision over the affected lymph node basin and carefully removes the cluster of lymph nodes along with surrounding fatty tissue. A drain is usually placed to collect fluid that builds up after surgery, and is removed days to weeks later depending on how much fluid drains.

Recovery and Healing

Recovery varies widely. A small facial excision may heal in a couple of weeks with minimal disruption to daily life, while a large excision with lymph node surgery and reconstruction can involve several weeks of restricted activity.

Immediately after surgery

• You may feel some soreness, tightness, or throbbing around the wound. Most patients manage well with paracetamol and, when needed, milder prescription painkillers.
• Bruising and swelling are common in the first few days.
• Dressings are kept dry initially. Specific instructions vary — some surgeons want the dressing left in place for several days, others allow gentle washing sooner.
• Stitches are usually removed 5 to 14 days after surgery, depending on the location (face stitches come out earlier; back and limb stitches stay in longer).

Wound care basics

• Keep the wound clean and dry as instructed.
• Watch for signs of infection: increasing redness, warmth, pain, swelling, pus, or fever.
• Avoid strenuous activity, heavy lifting, and stretching the wound area for the time period your surgeon advises — often two to four weeks.
• Avoid swimming pools, hot tubs, and prolonged soaking in water until the wound is fully closed.
• Protect the wound and the surrounding skin from sun exposure for at least 6 to 12 months to reduce scar darkening.

After a skin graft or flap

Reconstructive procedures need extra care. The graft site (where the new skin is placed) and the donor site (where the skin is taken from) both need to be protected. You may need to keep the area still and avoid pressure on it for several days. Your team will give detailed instructions.

After lymph node surgery

Recovery after sentinel lymph node biopsy is usually quick, with the small incision healing within a couple of weeks. Recovery after a full lymph node dissection takes longer:

• A drain may stay in place for one to four weeks.
• You may need physiotherapy to regain shoulder, leg, or neck movement.
• Lymphoedema (chronic swelling of the limb) can develop weeks, months, or years after surgery. Early signs include a feeling of heaviness, tightness, or visible swelling. Specialist lymphoedema physiotherapy is the standard approach.

Scarring

• Sun protection over the scar
• Silicone sheets or gels, started after the wound is fully closed
• Gentle massage once cleared by your surgeon
• For raised, thick, or itchy scars (keloid or hypertrophic scars), specialist treatments such as steroid injections may be considered

Risks and Complications

Skin cancer surgery is generally safe, but as with any operation, there are risks. Your surgeon will discuss the specific risks relevant to your procedure.

General surgical risks

• Bleeding: minor bleeding from the wound is common; significant bleeding is rare
• Infection: uncommon but possible; antibiotics may be needed
• Wound healing problems: including wound separation, delayed healing, or partial loss of a graft or flap
• Scarring: including thickened, raised, or unsightly scars
• Numbness or altered sensation: small nerves are inevitably cut during surgery; sensation may return partially or remain altered
• Reaction to anaesthetic: rare

Risks specific to lymph node surgery

• Seroma: a collection of fluid under the wound; may need draining
• Lymphoedema: chronic swelling of the affected limb, more common after complete lymph node dissection than after sentinel node biopsy
• Nerve injury: nerves passing through the lymph node area can be bruised or, rarely, cut, leading to weakness or numbness
• Reduced range of movement: in the shoulder, hip, or neck, often improved with physiotherapy

Risk of incomplete removal

Even with careful surgery, the pathology report may show that the cancer extends to the cut edge. This means further surgery is usually needed. With Mohs surgery this is generally identified and corrected during the same procedure; with standard excision it may require a return visit.

Risk of recurrence

Skin cancers can come back, either at the original site (local recurrence), in nearby lymph nodes (regional recurrence), or in distant parts of the body (metastasis). Recurrence is more likely for cancers that were larger, deeper, in certain high-risk locations, or had aggressive features under the microscope. Regular follow-up is designed to catch recurrence early.

Life After Skin Cancer Surgery

For most people with non-melanoma skin cancer, life after surgery returns to normal relatively quickly. For people with melanoma or higher-risk skin cancers, life after surgery involves a longer period of follow-up, monitoring, and sometimes additional treatments.

Follow-up appointments

Follow-up schedules vary by cancer type and stage. As a general pattern:

• Low-risk basal cell or squamous cell carcinoma: follow-up every 6 to 12 months, often with a dermatologist, for several years
• Higher-risk non-melanoma skin cancers: more frequent follow-up, especially in the first two years when recurrence is most likely
• Melanoma: follow-up schedules depend on the stage. Early-stage melanoma is typically followed every 6 to 12 months for several years. Higher-stage melanoma involves more frequent visits and may include regular blood tests and imaging

Follow-up visits usually include a full skin examination, palpation of the lymph node areas, and assessment of any new symptoms. For higher-risk melanomas, imaging such as ultrasound, CT, MRI, or PET-CT may be scheduled at intervals.

Adjuvant (additional) treatments after surgery

For some patients, surgery alone is not enough, and additional treatments are recommended:

• Adjuvant immunotherapy: for higher-risk melanomas, immunotherapy drugs that activate the immune system against melanoma cells are now a standard option after surgery. Major societies such as NCCN, ASCO, and ESMO have incorporated these into their guidelines.
• Targeted therapy: for melanomas with BRAF mutations, combination tablet therapies can be used after surgery in selected patients.
• Radiation therapy: may be used after surgery if margins are not clear, if there is nerve involvement, or in certain lymph node situations.

Whether any of these is appropriate is decided in a multidisciplinary discussion based on the pathology, stage, and your individual factors.

Protecting your skin going forward

Having had one skin cancer increases the chance of developing another in the future. Steps that doctors typically recommend include:

• Daily use of broad-spectrum sunscreen on exposed skin
• Wearing wide-brimmed hats, long sleeves, and UV-protective clothing
• Avoiding the midday sun and seeking shade
• Avoiding tanning beds
• Regular self-examination of the skin, looking for new or changing moles, sores that do not heal, or unusual growths
• Attending follow-up appointments and reporting any concerning changes between visits

For melanoma in particular, first-degree relatives may also benefit from skin checks, as there is a familial component in some cases.

Emotional impact

A skin cancer diagnosis, even of a highly treatable type, can be emotionally significant. Anxiety about recurrence is common and tends to be highest in the months around follow-up visits. Some people find it helpful to talk to a counsellor, join a patient support group, or discuss concerns with their treating team. For melanoma in particular, the experience of monitoring for recurrence over several years can be stressful, and structured psychological support is sometimes part of cancer care.

Frequently Asked Questions

How long will I be in hospital?

For most small skin cancer excisions and for Mohs surgery, the procedure is done as a day case — you go home the same day. For larger excisions with reconstruction, sentinel lymph node biopsy, or lymph node dissection, a hospital stay of one to several days may be needed.

Will I need general anaesthesia?

Many skin cancer surgeries are done under local anaesthetic, meaning you are awake but the area is numb. General anaesthesia is more often used for larger excisions, lymph node surgery, or complex reconstructions. Your team will discuss the safest option for you.

How big will the scar be?

The scar is usually longer than the original cancer because of the margin of healthy tissue removed and because the wound is closed in an elongated shape to lie flat. Your surgeon should show you the expected scar position before the procedure. Scars typically fade significantly over the first year.

When can I go back to work?

For a small excision under local anaesthetic, many people return to desk work the next day or within a few days. For larger surgery, lymph node procedures, or jobs involving physical activity, several weeks off may be needed. Your surgeon will give specific guidance based on your operation.

When can I exercise again?

Light walking is usually fine within a few days. Stretching the wound area, heavy lifting, and vigorous exercise are typically avoided for two to four weeks for standard excisions, and longer for larger or reconstructive procedures. Swimming is generally avoided until the wound is fully healed.

What does “clear margins” mean?

When the pathologist examines the removed tissue, they look at the edges to see whether cancer cells are present. If the edges show only normal tissue, the margins are “clear” or “negative,” meaning the cancer appears to have been fully removed. If cancer cells reach the edge, the margin is “positive” or “involved,” and further surgery is usually needed.

Will the cancer come back?

Recurrence rates depend on the cancer type, size, location, and other features. Most early skin cancers do not come back after complete surgical removal, but the risk is never zero. This is why follow-up appointments and ongoing skin self-checks are important.

If I had melanoma, do I need lifelong follow-up?

People who have had melanoma generally need long-term skin surveillance — usually for at least 5 to 10 years, sometimes lifelong, depending on the stage. The intensity decreases over time if there are no signs of recurrence. The same applies to people who have had multiple non-melanoma skin cancers, because they have a higher chance of developing more.

Can skin cancer surgery be done if the cancer is on my face?

Yes. Facial skin cancers are common and are routinely treated surgically. Mohs surgery is particularly often used for facial cancers because it removes the minimum amount of healthy tissue while ensuring complete cancer removal. Reconstructive techniques are well established for facial defects.

What if the cancer has spread to lymph nodes or other organs?

When skin cancer has spread, treatment usually involves a combination of approaches — surgery to remove affected lymph nodes where possible, plus systemic treatments such as immunotherapy, targeted therapy, or radiation. The treatment plan is developed by a multidisciplinary team and tailored to the specific situation.

How do I know I am being treated at a centre with the right experience?

Things that doctors and patient groups commonly suggest looking for include: a surgeon or dermatologic surgeon with specific training and experience in the type of skin cancer surgery you need; access to a multidisciplinary team (dermatology, surgical oncology, medical oncology, radiation oncology, plastic surgery, and pathology); the availability of techniques like Mohs surgery and sentinel lymph node biopsy on-site; and a clear plan for follow-up and adjuvant treatment if needed. It is reasonable to ask how often the team treats your specific cancer type.

Conclusion

Skin cancer surgery covers a wide range of procedures, from a brief in-office excision of a small basal cell carcinoma to a complex operation involving wide local excision, sentinel lymph node biopsy, and reconstruction for melanoma. The right approach depends on the type, size, location, and stage of the cancer, and on your individual factors and preferences.

For most skin cancers, surgery alone is curative, and for those that need additional treatment, the options — including modern immunotherapy and targeted therapy for melanoma — have advanced significantly in recent years. Understanding what your specific operation involves, what recovery will look like, and what the follow-up plan will be can help you feel more prepared as you move through treatment.

The conversations you have with your surgeon, dermatologist, and the wider multidisciplinary team are central to shaping the plan that fits your situation. Bringing your questions to those discussions — including the practical ones about scars, recovery time, and follow-up — is part of being an active participant in your own care.