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Skin Cancer
malignant skin lesions
The management of skin malignancies, including Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma requires a dual-focused surgical approach: achieving histological clearance of the malignancy while executing an aesthetic and functional restoration. Mr Nakul Patel specialises in reconstructive surgery, utilising advanced tissue-transfer techniques to repair defects following tumour excision. Whether you require a primary wide local excision or complex reconstruction following Mohs Micrographic Surgery, the priority is to eradicate the disease while preserving structural integrity, and long-term function.
Procedure Overview
The Different Techniques of Skin Cancer Removal
The choice of reconstructive technique is dictated by the anatomical location of the defect, the depth of the excision, and the requirement for structural support.
Skin Cancer Removal Journey
Before & After Gallery
View authentic transformations from real patients who have undergone Skin Cancer Removal with Mr Nakul Patel, showcasing natural, elegant results tailored to each individual’s anatomy and aesthetic goals.
Benefits of Skin Cancer Removal
Are You Suitable for Skin Cancer Removal?
You may be suitable if
- Confirmed or Suspected Cancer: You have a biopsy-confirmed or highly suspicious skin cancer.
- Mohs Surgery Repair: You are having Mohs surgery and want a plastic surgeon to perform the final repair.
- High-Risk Location: Your cancer is in a "high-risk" area like the face, where scarring is a major concern.
- Incomplete Prior Removal: You have been told a previous removal was "incomplete" and need further surgery.
Alternatives
- Non-Surgical Creams: Some very early, surface-level cancers can be treated with medicated creams, but this is not suitable for deeper or more aggressive types.
- Radiotherapy: X-ray treatment can be used if surgery isn't possible, though surgery is usually the preferred "gold standard" for a definitive cure.
The Procedure: What's Involved ?
Step 1: Numbing and Precise Removal
After marking the cancer and the required safety margins, a local anaesthetic is injected to ensure the area is completely numb. The surgeon then removes the lesion along with a margin of healthy tissue to ensure no cancer cells are left behind. If you are having a Post-Mohs reconstruction, Mr Nakul Patel begins at this stage by preparing the existing wound left by the Mohs surgeon for the restorative phase.
Step 2: Reconstructive Sculpting (Graft or Flap)
The "gap" is then meticulously repaired. For a Skin Flap, nearby healthy tissue is rotated or slid into the space while remaining attached to its own blood supply. For a Skin Graft, a small patch of skin is taken from a hidden donor site (like behind the ear) and placed over the wound. This stage ensures the nose, lips, or eyelids remain in their natural position without being pulled or distorted.
Step 3: Multi-Layered Closure and Protection
Using fine sutures, the skin edges are aligned to follow your natural creases. All removed tissue is immediately sent to a laboratory for formal histology. A specialised dressing, and in the case of grafts, a firm "bolster" pad is applied to protect the site and ensure the new skin develops a healthy blood supply during the first week.
- We decide between a graft, flap, or simple closure based on the size and location of the lesion.
- We map the repair to ensure vital features like the eyelid or lip remain balanced and functional.
- We discuss the specific amount of healthy skin that must be removed according to the cancer type (BCC, SCC, or Melanoma).
- We identify the most discreet area (e.g., behind the ear or collarbone) to harvest skin if a graft is required.
- We confirm the process for histological testing and how we will communicate your "clearance" results.
- We review any medications or habits (like smoking) that could impact the survival of the new skin graft or flap.
Preparing for Surgery
Avoiding Complications
Scarring: A scar is inevitable. Its size and shape depend on the cancer’s size and the reconstruction method used.
Swelling & Bruising: Particularly common when surgery is near the eyes or forehead.
Temporary Numbness: Small sensory nerves are often cut during excision; feeling usually returns slowly over months.
Redness: The scar will appear pink or red for several months before maturing.
Infection: Indicated by increasing pain, heat, or discharge.
Haematoma/Seroma: A collection of blood or fluid under the flap or graft that may require drainage.
Partial Flap/Graft Loss: Small areas of the edges failing to “take,” usually managed with specialized dressings.
Suture Reaction: Redness or “spitting” of the internal dissolvable stitches.
Recurrence: The cancer returning if microscopic cells were left behind (minimised by clear margin protocols).
Total Flap Failure: The blood supply to the moved skin failing completely, requiring a second reconstruction.
Nerve Damage: Damage to deeper “motor” nerves (e.g., those that move the eyebrow or lip), which can cause permanent weakness.
Frequently Asked
Questions about Skin Cancer Removal
What happens if the lab finds more cancer at the edge?
If the histology report shows "positive margins," we will schedule a second minor procedure to remove a bit more tissue from that specific area. This is a vital safety step to ensure the cancer does not return.
Why does my skin graft look different in colour?
A graft is a "patch," and it can initially look paler or darker than the surrounding skin. Over several months, the colour usually blends in as the blood supply matures, though a slight difference in texture is normal.
Will I have a "dent" where the cancer was?
Our goal with flap surgery is to move tissue into the gap to restore a flat, natural contour. For larger defects, we may use fat grafting later to fill in any minor depressions.
Can I wear my glasses after surgery on my nose?
If you have a graft or flap on the bridge of your nose, you may need to avoid wearing glasses for 1–2 weeks, as the weight can "pinch" the blood supply.
How do I know if the flap is failing?
We monitor the colour and temperature of the flap closely. If you notice the area turning very dark purple or black, or if it feels unusually cold, you must contact immediately
What happens if the histology report shows something suspicious?
If a lesion is found to be atypical or cancerous, Mr Nakul Patel will discuss the report with you in person. Mr Patel will perform further "wide local excisions" or reconstructive surgery if necessary to ensure your health and safety.
Is it safe to have this surgery while on blood thinners?
In most cases, we do not ask you to stop your blood thinners, as the risk of a clot is higher than the risk of minor bruising. We will discuss this with your GP or cardiologist during the planning stage.
Why is a "safety margin" necessary?
Skin cancers often have microscopic "fingers" or roots that are invisible to the naked eye. By removing a small margin of healthy-looking skin (usually 2mm to 5mm depending on the cancer type), we significantly increase the chance that 100% of the cancer is removed in the first go.
How soon can I apply make-up?
You must wait until the wound is fully closed and any crusting has disappeared, which is usually around 14 days. Once the "new" skin has formed, make-up can be very effective at hiding the pinkness of a fresh scar.
Will I lose hair in the area where the flap was moved?
If a flap is moved from a hair-bearing area (like the temple or scalp), the hair usually continues to grow in the new location. However, if the cancer was deep, the hair follicles in that specific spot may be lost. We plan our incisions to minimise any visible hair loss
Can I drink alcohol after the Skin Cancer Removal?
We recommend avoiding alcohol for at least 48 hours after surgery. Alcohol thins the blood and dilates blood vessels, which can increase the risk of post-operative bleeding, bruising, and swelling around your new reconstruction.