Surgery is the most common and effective treatment for basal cell carcinoma, or BCC, and several types of surgery are available. The surgical procedure recommended depends on the size, location, and subtype of the tumor, along with other factors. Dr. Alvarado, can you tell us about surgery for skin cancer?
Sure, Dr. Mayzik. There are several types of surgery used to treat non-melanoma skin cancers. Surgical excision is a common treatment that removes the growth with a scalpel. A border of skin around the tumor, called the margin, is also taken and examined under a microscope to be sure all the cancer cells have been removed. The size of the margin excised depends on the extent of the growth and type of cancer.
Electrodesiccation and curettage is often utilized to remove small skin cancers, such as superficial BCC, with a looped instrument called a curette. Other subtypes of BCC are typically too deep for this procedure, and there’s a risk of not removing the entire tumor. After the tumor is removed, an electric current is delivered to the area to control bleeding and destroy any residual cancer cells. This is usually a fast and simple procedure.
Mohs surgery, also called Mohs micrographic surgery, is a procedure that removes small margins of tissue around the cancer in layers. Each layer is then examined under a microscope. Layers continue to be removed until cancer cells are no longer visible. Mohs surgery has the highest cure rate of any BCC treatment. Because this procedure offers the most margin control, it’s often used for head, face, and neck cancers, and for large tumors. Additionally, it’s frequently used for skin cancers that have a higher risk of recurrence.
Another type of surgery is called cryosurgery. During the procedure, liquid nitrogen is applied directly onto the skin, freezing and destroying cancer cells. Cryosurgery can be used for a variety of benign or noncancerous conditions as well as precancerous areas. It’s not frequently used to treat BCC, as it has a lower cure rate than other procedures.
A skin graft or flap may be needed after surgery if the skin cancer removed was large or the affected area does not heal properly. Mohs surgeons are dermatologists who are specially trained in the Mohs technique, as well as cosmetic closures of large facial defects using skin flaps or grafts. During the graft, an area on another part of the body, such as the upper thigh, chest, or neck is numbed and a patch of healthy skin removed. The patch is then placed on the area where the growth was removed. The graft may need special care until it heals.