Skin Cancer Excision

About Skin Cancer Excision

Skin cancer excision is the surgical removal of a skin cancer together with a margin of surrounding normal tissue. It is the main treatment for basal cell carcinoma, the most common cancer in humans, for cutaneous squamous cell carcinoma and for melanoma. The width of the margin depends on the type of tumor, its size, location and risk features, and for melanoma on the Breslow thickness, the depth of invasion measured under the microscope. Mohs micrographic surgery, developed by the American surgeon Frederic Mohs in the 1930s, removes the tumor in thin layers that are examined immediately, so that the entire margin can be checked and as much healthy tissue as possible preserved; it is especially used for tumors on the face and for recurrent or high risk basal and squamous cell carcinomas, and has very high cure rates. Sentinel lymph node biopsy is used to stage selected melanomas, identifying the first lymph nodes that drain the tumor site with a radioactive tracer and blue dye. The MSLT II trial found that immediate removal of all remaining nodes after a positive sentinel node did not improve melanoma specific survival compared with ultrasound surveillance, which changed practice. The resulting defect can be closed directly, with a skin graft or with a local flap that moves nearby skin. For advanced melanoma, immune checkpoint inhibitors and targeted therapies against BRAF and MEK have substantially improved outcomes. Skin examinations are part of follow up because people who have had one skin cancer are at increased risk of others.