Skin Cancer Excisions & Mole Removals
About Skin Cancer Excisions & Mole Removals
When a skin cancer has been found, it needs to be treated. Most of the time, the treatment is by surgical excision (cutting the cancer out). Melanomas always need to be removed surgically. There are sometimes non-surgical options for early (superficial) basal cell carcinomas and early squamous cell carcinomas (called “in-situ”). See non-surgical treatments and PDT for more detail.
What is a surgical excision?
Surgical excision means removing (excising) a skin cancer with a surrounding area of normal tissue (a “margin”) by cutting it out with a very sharp surgical blade (scalpel). Surgical excision is the most effective way of removing skin cancers, and in many cases it is the only option to cure the cancer. The complexity of the excision may change depending on the site and size of the cancer to be treated.
FAQs about Skin Cancer Excisions & Mole Removals
What is an ellipse?
Most skin cancers can be removed by a “simple” excision called an ellipse. A “margin” (an area of normal tissue is drawn around the skin cancer or mole to be removed. An ellipse is then drawn to include the skin cancer and the margin. The ellipse of skin is excised (cut out), and the skin can then be closed into a linear wound. The removed skin is then sent to the pathology lab to check that the cancer has been removed with a clear margin of normal tissue around it.
What is a skin flap?
On some occasions it is not possible to remove a skin cancer using an ellipse, as there may not be enough “spare skin” or skin laxity to allow the wound to close without undue tension or distorting other structures. This is more common on the face (especially nose, ears and around the eyes), below the knee and on the hands and wrists. On these occasions a “complex closure” may be needed. As skin flap is when some skin close to a skin excision, in an area under less tension, is made mobile but cutting around it but keeping its blood supply intact. This “flap” of skin is then used to close the wound created by removing the skin cancer, allowing the area to heal better, and prevent distorting other structures such as the nose or eyelids. There are many different types of skin flap, and our doctors have had advanced training to know how to perform these techniques, and which type will work best in different situations.
What is a skin graft?
Sometimes, a “complex closure” is needed but there is no spare skin nearby to use to create a skin flap. In these circumstances a skin graft is needed. A skin graft involves taking a sheet or piece of skin from one body site and placing or stitching it over a wound at a different site to close it. Skin grafts must obtain a new blood supply from the surrounding healing tissue they are placed on, and so the wounds need to be carefully looked after to help the grafts to “take” (obtain a new blood supply). There are two different types of skin graft – “Full thickness” and “split” skin grafts.
In a split skin graft, the top part of an area of skin is shaved off and placed over a wound. This creates a deep graze at the site where the skin is taken from (the donor site). The split skin graft is laid down and may be sutured (stitched) into place. A bandage may be placed over the graft site on top of the dressing to apply pressure and prevent fluid build-up under the graft and reduce movement, helping the healing process.
A full thickness skin graft is when the skin used to close a wound contains the whole thickness of skin. This leaves a wound at the donor site that needs to be stitched together to close it. The donor site is usually closed as an ellipse (see what is an ellipse). The “donor site” used for the skin graft will be chosen to match the skin at the excision site as much as possible.