Excision of a known skin cancer with wide margins or excision of a scar where skin cancer has been removed but greater tissue margins are required. This operation is commonly used to adequately excise melanoma and may be required for non-melanoma skin cancers including squamous cell carcinoma or basal cell carcinoma.
Variable margins are recommended to reduce the risk of recurrence for melanoma, squamous cell carcinoma and basal cell carcinoma. A Wide Local Excision is to ensure adequate margins are taken. It can often be done under local anaesthetic.
Often, when a skin lesion is first excised or biopsied it is not known to be cancer and a second procedure is required once the diagnosis is confirmed to get good margins. Obtaining adequate surgical margins decreases the risk of a skin cancer recurring at the site of excision. The amount that needs to be taken depends on the type of cancer and how deep the cancer is.
This procedure can often be done using local anaesthetic to numb the area. If a sentinel node biopsy is also required due to a diagnosis of melanoma, then a general anaesthetic will be required. The skin lesion or scar is excised with a cuff of normal appearing skin around it, the amount of normal skin (margin) needed varies depending on the type of skin cancer. Often the skin can be closed with sutures but for larger excisions a skin flap or graft may be needed. A skin flap borrows tissue that is close by, the tissue is able to be rotated into the area where the cancer was removed and the site where the flap is taken from is closed with sutures. A skin graft borrows skin from elsewhere in the body which is then used to cover the site from where the cancer was removed. If you need a skin flap or skin graft this will be discussed with you before the operation.
Bleeding. Infection. Need for a further procedure. There are additional risks of having a flap or graft including failure of the flap/graft to take.
If you require a general anaesthetic, you cannot eat or drink for 6 hours before the operation. You are admitted on the day of your operation.
Most people are able to go home on the same day as the procedure. The effect of the local anaesthetic will wear off after 4 – 6 hours. You should take regular simple pain relief. You will be followed up in the rooms in 2 – 3 weeks time once your results are available. If you have a flap or graft, I will usually arrange to see you within 1 week to remove the sutures and review the wounds.