Surgical Treatment Options:
**Please see below for overviews and procedure explanations for each option**
If you have skin cancer, a surgical excision might be recommended. Surgical excision is the removal of skin cancer along with a margin/rim of perceived healthy tissue. Excision allows for the complete removal of skin cancers such as basal cell carcinoma, squamous cell carcinoma, or melanoma.
Surgical excisions are performed in the office, without the need for a hospital visit or general anesthesia. The spot to be excised is circled with a surgical marker. A “margin” or area of healthy appearing tissue around the lesion is then also marked along with any additional area that needs to be removed to allow for wound closure. A local anesthetic is administered to rapidly numb the area of the skin involved. The dermatologist will then cut around and under the likely extent of the skin lesion. Removal of a standard margin of healthy tissue maximizes the chance that all the cancerous tissue will be removed. Some minor bleeding may occur, for which the physician might cauterize the area. Any pain is usually mild and quickly corrected with additional anesthesia. Excisions are closed with stitches and generally heal without complications. Depending on individual patient circumstances, antibiotics may be prescribed. The pathologist will check the margins of the excisions to make sure they are clear of the tumor. If the tumor is still present, you will need to return to the physician’s office for another excision of the lesion. However, the size of the margins is selected to ensure that additional procedures are rarely necessary.
**Please follow instructions given to you by your physician for optimal healing**
If you have skin cancer, MOHs surgery might be recommended. Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. Mohs surgery is also known as Mohs micrographic surgery.
The Mohs surgeon will examine the location where you had your biopsy and may mark it with a pen for reference. The doctor positions you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you can’t see what’s happening, but the doctor talks you through it. The surgeon then injects local anesthesia, which numbs the area completely. You stay awake throughout the procedure. Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may have roots or extensions that aren’t visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily, and you can relax while the lab work begins.
The surgeon cuts the tissue into sections, color codes them with dyes, and draws a map of the surgical site. In the lab, a technician freezes the divided tissue, then cuts very thin horizontal slices like a layer cake. The slices are placed on microscope slides, stained, and covered. Using a microscope, the surgeon examines all the edges and underside of the tissue on the slides and, if any cancer cells remain, marks their location on the map. The physician then lets you know whether you need another layer of tissue removed.
** This entire process is repeated as many times as needed until
there are no more cancer cells**
Once the site is clear of all cancer cells, the wound may be left open to heal or the surgeon may close it with stitches. This depends on its size and location. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a skin graft. In some cases, your Mohs surgeon may coordinate the repair of your wound with another specialist. In most instances, however, the Mohs surgeon will repair the wound immediately after obtaining clear margins. Carefully follow your doctor’s instructions for wound care, scar care, and follow-up to achieve the best outcome.
If you have recently been diagnosed with skin cancer or you have an area of concern and would like to learn about skin cancer treatment options including Excisions & MOHs surgery, contact Advance Dermatology & Laser Medical Center in Marina Del Rey, CA for a consultation with Dr. Nita Patel.