Types of surgery for larger skin cancers
There are different types of surgery for larger skin cancers or cancer that has spread.
These include surgery to:
- remove more tissue (wide local excision)
- repair your skin with a skin graft or skin flap
- remove nearby lymph nodes
For smaller skin cancers your doctor can remove just the cancer and a small border or healthy tissue.
Surgery to remove more tissue (wide local excision)
What is it?
Wide local excision is surgery to remove a larger area of healthy skin and tissue. You have this surgery if the doctor thinks there might still be skin cancer cells in the tissue near to the skin cancer. Removing this wider area of tissue helps reduce the risk of the cancer coming back.
How you have it
You might have this treatment while you are awake, with a numbing injection (local anaesthetic). Or under general anaesthetic, so you are asleep for the operation. The amount of tissue the doctor removes depends on:
- the size and type of the cancer
- where it is on the body
- how much tissue was taken away if you had an excision biopsy
You usually have stitches to close the wound. This might feel a little tight at first. As it heals, the surrounding skin will stretch and the tightness should ease.
Sometimes the doctor removes a large area of skin. To repair this you might need a skin graft or skin flap.
Skin graft and skin flaps
You need to have the area of skin replaced (repaired) if you have a large area of skin removed. This can be done with a skin graft or skin flap. You have either a local or general anaesthetic.
After skin grafting or skin flap repair, your nurses and doctors will keep a close eye on your wound site. This is to make sure the site is getting a good supply of blood, which brings oxygen and nutrients to the healing tissues.
What is it?
A skin graft is a thin sheet of skin that your surgeon removes from another part of your body (donor site). They use it to cover the area of skin they remove. The donor site usually comes from somewhere not too obvious, such as your inner thigh.
How you have it
You have a skin graft during the operation to remove your cancer. A plastic surgeon usually does the operation. The surgeon shaves off the sheet of skin (using a special instrument), or cuts out the donor site. You have a dressing on the donor site.
You don't usually need stitches if your surgeon shaves the donor site. It will heal on its on. You have stitches to repair a donor site that has been cut away
The skin graft is very delicate while it heals. It's very important that it is not damaged or knocked while healing. Your doctor and nurses will be very careful that your wound doesn't become infected. You may have antibiotics to prevent this.
A disadvantage of skin grafting is sometimes the skin looks different from the surrounding area. It may be a slightly different colour and appear as a dent compared to the surrounding skin.
What is it?
A skin flap is another way to repair a large wound. The surgeon uses a flap of skin and the tissue from underneath it (subcutaneous tissue). The skin flap has its own blood supply and comes from an area next to where the skin cancer was.
Skin flaps often look better than a skin graft. So your doctor might suggest a skin flap for body parts where the skin appearance is most important - for example, on your face.
There are different types of skin flaps. You might need more than one operation. Your surgeon will explain what you need before you have the operation.
How you have it
Doctors take the flap from close to your wound. The cut (incision) is usually deeper than that of a skin graft, but the skin is left partly connected to its original site. This means the skin flap is still connected to your blood supply so is likely to heal well. The flap is then positioned over your wound and stitched in place.
The surgeon uses stitches to close the area where they took the skin flap from. In some cases you might need a skin graft to close this site.
Only specially trained dermatologists (a skin specialist) or plastic surgeons do skin flaps.
Lymph node removal
What is it?
You have an operation to remove nearby lymph nodes if there are cancer cells in the nodes. This is rarely necessary. This type of operation is more common for squamous cell skin cancers.
How you have it
A specialist surgeon does the operation. You have a general anaesthetic, so you are asleep during the operation.
The type of surgery you have depends on where the skin cancer is. There are large groups of lymph nodes in the neck, armpit and groin. So for example, if you have a skin cancer on your scalp or face, the surgeon might need to remove the lymph nodes on the same side of your neck.
Side effects
There are side effects from this type of surgery. You're likely to be in some discomfort after the operation and healing can take several weeks. Some people have long lasting problems with pain after lymph node surgery.
Shoulder stiffness and pain are the most common problems when the surgeon removes lymph nodes from under your arms. This should get better as the area heals. You may find that you are unable to move your arm as freely as you could before the surgery.
The most common problem with lymph node removal in the groin is swelling of the leg on the same side (lymphoedema). A combination of exercise and massage can help to control it. And wearing an elastic stocking on the affected arm or leg can also help.
Talk to your doctor or clinical nurse specialist if you are having problems.
Adjuvant treatment
This is treatment after surgery to try to lower the risk of cancer coming back. Your doctor may suggest radiotherapy after your surgery if they think that some cancer cells may have been left behind.
