Surgical Procedures: Surgery and Staging for Non-Melanoma Skin Cancer

Cancerous cells in the skin are called skin cancer. Skin cancer starts in the outer layer of the skin (epidermis). There are two main types of skin cancer: non-melanoma and melanoma. This article focuses on non-melanoma skin cancers. The most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. These cancers don’t often metastasize (spread) to other parts of the body. 

What is staging and how is it performed?

Staging is a way to find out if and where the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For non-melanoma skin cancer, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues. A thorough skin exam will be done. 

Biopsy: A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample under a microscope in a laboratory. There are many types of biopsy, including:

• Shave biopsy: A sterile razor will shave off any abnormal appearing growth.
• Punch biopsy: A circular piece of abnormal-appearing tissue is removed using a tool called a punch or trephine.
• Incisional biopsy: A scalpel is used to remove part of the abnormal-looking area of skin/growth.
• Excisional biopsy: A scalpel is used to remove the entire abnormal-looking area of skin/growth.
• Lymph node biopsy: Lymph nodes may be removed and tested to see if the cancer has spread.

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include:

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan). 
• Magnetic resonance imaging (MRI). 

Cancer stage determines how extensive the cancer is, how far it has spread and what treatment course will be recommended. Non-melanoma staging depends on the presence of possible "high-risk" features (or if the lesion is on the eyelid). Stages of non-melanoma skin cancers are described as stage 0 (carcinoma-in-situ) through stage IV disease. Treatment of the cancer will depend on its stage and type.

Surgical Procedures for Non-Melanoma Skin Cancer

Surgery is often used to treat skin cancer. The procedure used will depend on many factors, including the size and location of the cancer. Your care team will talk to you about your specific procedure. 

Surgical procedures used to treat skin cancers include:

Mohs micrographic surgery: The cancer is removed in layers and looked at right away under a microscope to see if there is cancer in that layer. The surgeon will stop removing layers once cancer cells are no longer seen.

Simple excision: The tissue/tumor is removed with a part of the surrounding normal-appearing skin.

Shave excision: A scalpel/blade is used to shave off part of the abnormal-appearing surface skin.

Electrodesiccation and curettage: The tumor is removed with a special spoon-shaped tool. An electrode cauterizes (burns) the area, stopping bleeding, and killing any remaining cancerous cells.

Cryosurgery: Abnormal cells are frozen and destroyed.

Laser surgery: A laser beam is used to cut/remove abnormal tissue.

Dermabrasion: The surface layer of skin is rubbed away with a special tool.

In some cases, skin grafting may be used to close the wound. When this is needed, skin from another part of the body may be used. Some patients may need or want reconstructive/plastic surgery.

What are the risks associated with non-melanoma skin cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Infection.
• Bleeding.
• Scarring.
• Pain.
• Change in how the skin in the area looks and works.
• Skin graft rejection (if skin grafts are needed).
• Nerve damage.
• Cancer recurrence (the cancer coming back).
• Incomplete cancer removal.
• Change in how you look. 

Contact your healthcare team if you have:

• Fever or chills (your care team will tell you at what temperature you should call them).
• Redness, swelling, pain, bleeding, or drainage at the incision.
• A new opening of your incision or stitches.
• Any new or worsening pain. 

What is recovery like?

Recovery from surgery will depend on the extent of the procedure you have had. Your healthcare team will talk to you about caring for your incision at home. Your medical team will discuss with you the medications you may be taking, such as those for pain, and blood clot prevention and/or other conditions.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that you can go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.