Skin Cancer Surgery

Suspected melanoma, squamous cell carcinoma, and other higher-risk skin cancers are managed via the NHS urgent suspected-cancer pathway. NICE guidance states that a diagnosis should be confirmed or ruled out within 28 days of referral. Mr Patel works within this pathway alongside referring GPs and dermatologists to ensure prompt assessment.

For the majority of BCCs and SCCs, surgery alone is curative and no further treatment is required. Additional treatment — such as adjuvant radiotherapy or, for advanced melanoma, immunotherapy or targeted therapy — is reserved for higher-risk or more advanced cases and is planned by the multidisciplinary team where needed.

Standard excision removes the tumour with a defined margin and checks a sample of that margin under the microscope afterwards; if margins are involved, further surgery follows. Mohs surgery examines 100% of the margin in real time, layer by layer, while you wait, achieving cure rates of up to around 99% for new basal cell carcinomas and 95–99% for new squamous cell carcinomas — the highest of any skin cancer treatment — while removing the least possible healthy tissue. Mohs is generally reserved for higher-risk, recurrent, or facial tumours (especially morphoeic BCCs); most other skin cancers are well treated with standard excision.

It depends on the size, site, and type of cancer, and how the defect is closed. Many defects can be closed directly with a fine linear scar; larger or more complex defects — particularly on the face — may need a local flap or skin graft, which Mr Patel plans at your first consultation alongside the excision itself, so the reconstruction is never compromised by trying to keep the scar smaller than is oncologically safe.

All excised tissue is sent to a pathology laboratory, where the margins are examined under the microscope to confirm the tumour has been fully cleared. You'll usually get this result within 1–2 weeks; if any margin is involved, Mr Patel will discuss further surgery to ensure complete clearance.

Having had one skin cancer does increase the likelihood of developing further lesions, particularly with a history of significant sun exposure. Mr Patel will discuss an appropriate surveillance plan with you — often in conjunction with your dermatology or GP team — so that any new lesions are picked up early.

Most skin cancer surgery is done under local anaesthetic, so you'll feel a brief sting as the area is numbed and then nothing further during the procedure itself. Afterwards, most patients describe mild tenderness rather than significant pain, well managed with simple pain relief.

It's a procedure to check whether cancer cells have spread to the nearest lymph node, done under general anaesthetic at the time of your main surgery. It's recommended for melanomas of intermediate or greater thickness and for some higher-risk SCCs, to help stage the disease accurately and guide any further treatment — Mr Patel will advise if this applies to you based on your specific diagnosis.