Surgery

Simple excision
The tumour is cut out, along with some surrounding normal (non-cancerous) skin, and the remaining skin is stitched back together.

Simple excision is most often used to treat squamous cell carcinomas. It is sometimes used to remove basal cell carcinomas, along with a margin of normal skin. After this kind of surgery is used to remove smaller basal cell tumours, cancerous tumours return in about 12 percent of cases; when this surgery is used to remove larger tumours, they return in about 23 percent of cases.

Electrodesiccation and curettage
The doctor removes the cancer by scraping it away with a long, thin instrument, called a curette. Then an electric needle is used to destroy any remaining cancer cells in the area where the tumour was. This process is repeated one to three times.

Electrodesiccation and curettage is the treatment most often used for basal cell carcinomas. Following this treatment, about five percent of small tumours (those less than 5 mm in diameter) will reappear within five years.

Electodessication and curettage is also useful for treating small squamous cell carcinomas, but this procedure is not recommended for larger tumours.

Cryosurgery
Cryosurgery (also sometimes called cryotherapy) uses liquid nitrogen to freeze and kill abnormal cells. After the dead tissue thaws, blistering and crusting may occur. The wound may take several weeks to heal and the treated area may have less colour after treatment.

Cryosurgery is used for some small basal cell and squamous cell carcinomas but it is not recommended for large, invasive tumours or those on certain parts of the body, including the nose, ears, eyelids, scalp or legs.

Mohs surgery (microscopically controlled surgery)
A specially trained Mohs surgeon removes the skin cancer one thin layer of skin at a time. After each sample is removed, it is checked under a microscope. If it contains cancer, more pieces will be removed and examined until the skin samples are found to be free of cancer cells. This process is slow, but it preserves much of the normal skin next to the tumour. Mohs surgery successfully cures 95-99 percent of basal cell skin cancers and 92-95 percent of squamous cell skin cancers. Mohs surgery is used on tumours that are growing quickly, on tumours that have recurred after previous treatment, on cancers in particularly visible areas, and on tumours near important structures such as the eye, ear, lip or nose.

Mohs surgery has the best cure rate for basal cell carcinoma. It is often used to treat:

• large tumours
• tumours that have recurred after treatment
• tumours found on or near the nose, lip, eyes, ears, forehead, scalp, fingers and genital area

Mohs surgery may be used when basal cell carcinoma has reoccurred following a different form of treatment. The cure rate for basal cell carcinomas in this situation is about 96 percent. For reoccurring cancers, the cure rate is about 50 percent for most other types of treatment.

Mohs surgery also has the highest cure rate for squamous cell carcinoma. It is best for:

• large tumours
• tumours that have come back after other treatments
• cancers that are spreading along nerves under the skin
• cancers on delicate areas, such as the face or genitals

Shave excision
A small sterile blade is used to shave off the abnormal area of the skin.

Laser surgery and photodynamic therapy (PDT)
This relatively new  approach uses a beam of laser light to kill cancer cells. It is useful for squamous cell carcinoma in situ and for some basal cell carcinomas. It's not yet known whether laser surgery works as well as other standard methods of treatment. It is not commonly used to treat nonmelanoma skin cancers. Follow-up is essential for this treatment because it does not destroy any cancer cells that are deep under the skin's surface. This treatment still requires more testing before it can be offered for general use in the treatment of skin cancers.

Lymph node surgery
If lymph nodes near the cancer are growing larger, it may be a sign that the cancer has spread to these nodes. In this case, the nodes will be removed using an operation called a lymph node dissection. Patients are usually given a general anesthetic. Tissue from the removed nodes is examined under a microscope to see if cancer cells are present. Because lymph nodes help drain fluid, a possible long-term side effect of this surgery is the build-up of fluid and swelling in the area.

Skin grafting and reconstructive surgery
After removing a large nonmelanoma skin cancer, it may not be possible to stretch the nearby skin enough to sew it back together. In these cases, skin grafts or reconstructive surgery can be used to help the wound heal, to replace tissue, and to restore a more natural appearance.

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