Skin Cancer Removal

Standard Excision

Skin cancer excisions are best performed by board-certified dermatologists (Board-certified dermatologists have been accepted to, and completed at least four years of rigorous training in one of the most competitive medical residencies in the United States. With this extensive training, they are able to diagnose and treat more than 3,000 diseases of the skin, hair, and nails). Read More

Skin biopsies are not sufficient to treat a skin cancer because a margin (area of unaffected skin beyond the skin cancer) must be surgically removed before it can be considered as “treated.” Skin cancers which are classified as lower risk and early-stage melanomas may be excised in our clinic with a procedure called a standard excision. Lower risk skin cancers are usually located on the body, arms, or legs and have no “high risk” microscopic features (such as poor cancer differentiation, cells falling apart, etc.). This procedure involves the following steps:

• Consent - the patient is advised of the risks and benefits of the procedure and asked to give his/her “informed consent”
  • Risks - pain, scar, bleeding, infection
  • Benefits - skin cancer cure with low risk of recurrence
• Sterilization of the surgical site with chlorhexidine
• Surgical site confirmation and marking
  • Photos of the biopsy are reviewed and the site is marked. The margin is determined using NCCN guidelines and measured around the skin cancer (e.g., 4-6 mm margin for basal and squamous cell carcinoma without high risk features, 5-10 mm margin for melanoma in situ, 10 mm margin for melanomas less than 0.8 mm thick).
• Local anesthesia (numbing) is injected around the site
• Surgical removal of the skin cancer and margin of normal tissue

• Many sites on the body require the removal of additional triangles of tissue called “standing cones” or “dog ears” to enable the surgeon to close the circular wound with stitches in a manner that does not leave unsightly bumps on the skin
• Closure of the surgical site with layered stitches
  • Stitches below the skin dissolve in 2-3 month’s time
  • Stitches above the skin may dissolve or need to be removed in 1-2 week’s time
• Bandaging - Bandaging is applied by the medical assistant or nurse and is usually recommended to be kept in place for 48 hours.
• Reference: The American Academy of Dermatology

Wound care

Wound care may begin 48 hours after surgery, when the initial bandage is removed. Wounds should be saturated and soaked with dilute acetic acid (1 part vinegar to 4 parts water dilution) twice per day until completely healed (7-10 days on upper body, 10-14 days on lower body). Wounds should always be kept moist with a large amount of petrolatum/Vaseline and covered with a bandage (gauze and paper tape or a hydrocolloid dressing) to prevent them from drying out or becoming contaminated by the environment. Skin wounds should never be touched with an unwashed hand. Any worsening pain after 48 hours or prolonged healing times should prompt communication with the clinic.

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Scarring and scar care

Scars are best prevented rather than treated by meticulously following wound care instructions and limiting activity for two weeks following surgery. Scar care begins after surgical or biopsy wounds have completely healed (usually 2-3 weeks). Supportive, silicone-based scar dressings are best to promote ongoing healing of a new scar. They work best if worn 24 hours per day and only changed with bathing. Silicone scar pads may be impractical on the face, so patients may consider gentle scar massage with a silicone-based scar gel every day, with application of the scar pad at night.

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