Skin Cancer Surgery

Skin cancer is the most common cancer in the UK and encompasses a wide spectrum of disease, ranging from slow-growing, locally destructive tumours to aggressive lesions with the potential to spread. Early diagnosis and appropriate surgical treatment offer the best chance of cure for most skin cancers. Mr Singh works closely with dermatology, oncology and radiology colleagues as part of a specialist skin cancer multidisciplinary team to ensure each patient receives the most appropriate treatment plan.

Basal Cell Carcinoma (BCC)

BCC is the most common form of skin cancer and typically arises on sun-exposed areas such as the face, scalp, ears, neck and back. It grows slowly and very rarely spreads to other parts of the body, but can cause significant local tissue destruction if left untreated. Surgical excision with an appropriate margin of healthy tissue is the gold standard treatment for most BCCs.

Squamous Cell Carcinoma (SCC)

SCC is the second most common skin cancer and arises from the keratinocytes of the epidermis, often on sun-exposed sites. Unlike BCC, SCC has a small but real potential to spread to local lymph nodes or further afield, particularly when large, deeply invasive or poorly differentiated. Wide local excision with clear margins is the mainstay of treatment and some patients may need additional investigations or treatment to the regional lymph nodes.

Melanoma

Melanoma arises from the melanocytes (pigment-producing cells) of the skin and can behave aggressively with a significant potential to spread. It is the skin cancer most responsible for skin-cancer-related mortality. Initial treatment involves excision biopsy of the suspicious lesion, followed, once the diagnosis and thickness (Breslow depth) are confirmed on histology, by a wider local excision with defined margins based on national guidelines. In selected cases, sentinel lymph node biopsy is recommended for staging.

• Curative treatment: Surgical excision offers the highest cure rates for most non-melanoma skin cancers and for early-stage melanoma.
• Histological confirmation: The specimen is carefully examined by a pathologist to confirm the diagnosis, assess margins and stage the disease.
• Margin control: A defined margin of normal-appearing skin is excised around the tumour to reduce the risk of local recurrence.
• Immediate reconstruction: In most cases, the defect created by excision is closed or reconstructed in the same operation, restoring form and function.
• Specialist MDT care: Mr Singh participates in a skin cancer multidisciplinary team to ensure your care is planned and reviewed with other specialists.
• Tailored approach: The surgical plan is individualised to the tumour type, size, location and your overall health.

The surgical approach depends on the type of cancer, its size and location, and the need for reconstruction. Mr Singh will discuss the recommended plan with you during your consultation.

• Excision biopsy: For suspected melanoma the entire lesion is usually removed with a narrow 2mm margin to enable the pathologist to determine the diagnosis and Breslow thickness.
• Wide local excision: The tumour is removed with a predefined margin of clinically normal skin, typically 4mm for BCC, 4–6mm for SCC and 1–2cm for melanoma depending on Breslow thickness, in accordance with national guidelines. The depth of excision is also tailored to the tumour.
• Primary closure: Where the defect is small, the wound edges can be brought together directly with sutures to achieve a fine linear scar.
• Local flap reconstruction: When a simple closure would distort surrounding structures (particularly on the face), a local flap of adjacent skin and soft tissue is mobilised to fill the defect whilst preserving function and appearance.
• Skin grafting: For larger defects, a split-thickness or full-thickness skin graft may be harvested from another part of the body and inset into the wound.
• Margin assessment: The excised specimen is carefully orientated and sent for histological examination; if any margin is found to be involved, further surgery may be required.

Wound Care

• Dressings: Dressings vary depending on the reconstruction; local flap dressings are usually kept dry for 48 hours whilst skin grafts often require a bolster dressing which stays in place for 5 to 7 days.
• Cleaning: Once dressings are removed, gentle cleaning with mild soap and water is encouraged and daily showering helps to keep the wound clean.
• Sutures: Facial sutures are typically removed at around 5 to 7 days; sutures elsewhere at 10 to 14 days. Deep sutures are usually absorbable.
• Activity: Light activities can usually be resumed within a few days, but vigorous exercise and heavy lifting should be avoided for 2 to 4 weeks depending on the size and site of surgery.

Scar Advice

• Scar Care Products: Silicone gels or sheets and regular moisturising help optimise the appearance of scars.
• Sun Protection: Sun protection is essential not only to improve scar appearance but also to reduce the risk of further skin cancers. Use a high factor sunscreen daily and avoid sunbeds.
• Massage: Once fully healed, gentle scar massage can help soften and flatten the scar.

• Initial Post-Op Visit: Typically scheduled around a week following surgery to check wound healing and remove sutures if needed.
• Histology & MDT: Results are discussed at a specialist skin cancer multidisciplinary team meeting. You will be contacted with the result and any recommended next steps, usually within 2 to 3 weeks.
• Surveillance: Formal follow-up in a skin cancer clinic is arranged in line with national guidance, with the interval and duration depending on the type and stage of the cancer.
• Self-Examination: You will be advised on how to examine your skin and lymph node areas regularly and when to seek urgent review.
• Long-Term Care: Mr Singh remains available for any concerns or further follow-up as required throughout your surveillance period and beyond.