The following is a brief introduction to some of the surgical techniques used in the treatment of skin cancer...
A biopsy is where a sample of skin is taken for analysis to determine whether it is cancerous or not. There are three main methods of conducting a biopsy on the skin:
Excision – where a surgical knife is used to removed the tissue and some of the surrounding normal tissue.
Punch – a small circle of skin is removed.
Shave – this is where a thin layer of the top of the skin is removed for analysis.
Excision / Wide Area Excision / Re-Excision
These are all terms that refer to the surgical removal of a lesion or mole on the skin. It is referred to as re-excision since it generally follows an initial excision biopsy. The surgeon removes what is called a 'margin' of healthy tissue around the site of the lesion to ensure no abnormal cells remain. Generally speaking the larger the lesion or mole, the large the margin needs to be around it.
A flap repair is a surgical technique used where the tissue that is removed is too large for the skin on either side to be simply sewn together. In a form of skin graft, a section of skin adjacent to the site of the lesion or mole is removed and covers the site of the lesion or mole. This technique preserves the look and feel of the skin and leads to quicker recovery times, since the blood supply is left intact.
Mohs surgery is a relatively new type of surgery where very thin, almost microscopic layers of skin are surgically removed from the site of a lesion and immediately examined for the presence of cancerous cells. If cancer cells are found then another thin layer is removed and examined. This process continues until a layer is removed which contains no cancer cells at all.
Mohs surgery is used where the site of the cancer is in specific locations, such as near the eyes or on the ears or fingers. It is also used where the risk of the cancer returning is high or where there is uncertainty about how much the cancer has spread.
Due to the nature of the technique, Mohs surgery does take longer than conventional surgery, but can result in improved outcomes.