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 it is

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 food to the healing tissues.

Lymph node removal

What it is

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.

Related links