Excision of a Non-Melanoma Skin Cancer

Excisions of Non-Melanoma Skin Cancers
by Hannah Heimdal

Receiving a call from our office confirming that a biopsy site is either basal or squamous cell skin cancer is never a good feeling. The good news is that you are in good hands at Derick Dermatology. Now that your provider has informed you, your provider would now like to schedule a time for you to come in and get the spot excised. A million questions may be running through your mind, and this blog post is here to help!

First things first, what exactly is an excision?
An excision is the removal of a skin cancer along with some of the healthy skin tissue around it, also known as the margins.

What exactly is the difference between basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)?
Basal cell carcinoma (BCC)–also known as the most common type of skin cancer in the United States–is the least deadly. This type of skin cancer is slow-growing and seldom spreads to other parts of the body.

Squamous cell carcinoma (SCC) also rarely spreads but does so more often than basal cell. Squamous cell carcinoma are important to be treated early because they have the possibility of invading and destroying nearby tissue.

So, if they rarely spread, why don’t we just let them go?
Although melanoma is responsible for the vast majority of skin cancer related deaths, it only accounts for 1% of all skin cancers diagnosed. So what if you are in the other 99%? You have been diagnosed with squamous or basal cell carcinoma. The good news is that squamous and basal cell skin cancers are rarely fatal and are highly curable when caught early. Now the not so good part: these also require prompt treatment. If we all decided to let these non-melanoma skin cancers go without treatment, you might suffer disfigurement and a long list of other serious complications. These cancers may grow deep enough, if left untreated, to affect the underlying nerves, cartilage, and even bone. So at the end of the day, non-melanoma skin cancers are not growths you should ignore or postpone treatment.

I’ve heard of Mohs surgery but not an excision. What is the difference?
You may be wondering, why isn’t my dermatologist doing a Mohs surgery, which is the procedure most people hear for skin cancer. Typically, standard excision works well to remove non-melanoma skin cancers in areas that have extra skin, like legs and the stomach. Mohs surgery is reserved for areas where it is important to save as much skin as possible, such as the face or ear. Also, Mohs is done for aggressive types of BCC and SCC and in patients who have a suppressed immune system.

The margins also differ between Mohs and a standard excision. Margins, or the outermost layer of skin removed, are determined in these excision removals by including a small amount of healthy-looking tissue. Surgeons do this because it’s not possible for them to make a decision just by looking at the spot and how far the cancer has extended. In comparison, when Mohs surgery is done, one layer of tissue is removed after another and examined under the microscope to see if the margins are cancer-free. As soon as they are cancer-free, the Mohs surgery is over—thus this technique eliminates the “estimation” most surgeons have to make in how far out the skin cancer has spread.

How well does Mohs surgery work?
Success rates of standard excision removals are extremely high, and success rates for Mohs surgery is even higher. Standard excision treatment for basal cell carcinoma is as high as 95 out of 100 people, and squamous cell carcinoma is as high as 92 out of 100 people.

What are the different methods my dermatologist may use to close the excision site?
There are several options the provider may recommend in terms of closing the area after the cancer is removed. Typically, excision sites are closed with stitches; however, if the excision site is too large, they may decide to leave the site open. Don’t be worried if the provider chooses to leave the excision site open because, contrary to popular belief, this actually is acceptable so long as the site is properly cleaned and covered. The healing time can be weeks to months in wounds left to heal without sutures. The dermatologist may also need to do a skin graft or flap to cover the site.

The other good news about excisions is that the margins will be sent to our pathologists who will examine skin tissue in the lab to determine if any cancer cells still remain outside the area of skin that was removed. If there are any signs of remaining cancer, our office will give you a call to set up another appointment ASAP and have the remaining cancer removed to reduce the risk of recurrence.

Post-surgery, what are the aftercare instructions for the excision site?
After the excision, it is important to follow your provider’s instructions on how to care for your wound. Typically, the instructions will vary slightly based on the excision site, size of the excision, and your dermatologist’s preferences, but some general advice includes the following:
1.  Wash around the wound with clean water twice a day.
2.  Cover the wound with a thin layer of Vaseline and a non-stick bandage.

If stitches were used, you will need to return to the office and have them removed between 5-14 days after treatment. Call our office or seek immediate medical care if you have signs of serious infection, such as a fever, pus draining from the wound, and/or increased redness around the area.

After being diagnosed with any form of skin cancer, it is extremely important to return at LEAST once a year for full body skin exams. Annual exams are essential because many people treated for one skin cancer might have a higher likelihood for developing other skin cancers later in life.

Ask your dermatologist any other questions you may have on the day of your appointment. You can find more information on the surgical section of our website: https://derickdermatology.com/surgical/skin-cancer-excision/