Information about the procedure
Surgical treatment of basal cell carcinoma, squamous cell carcinoma and other skin tumours, with oncological margin control.
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What it involves
Skin cancers are the most common malignant tumours in humans. Basal cell carcinoma (BCC) accounts for about three quarters of them; it grows slowly and rarely spreads to distant sites, but it can destroy tissue locally.
Squamous cell carcinoma (SCC) is more aggressive and has a real potential to spread (metastasise). Melanoma requires a separate approach and wider margins.
The core principle of treatment is complete excision with clear margins. The oncological part always comes before the aesthetic one — first the tumour is removed safely, then we decide how to reconstruct the defect.
Types and approaches
Excision with clear margins
The tumour is removed together with a rim of healthy tissue. The width of the margin depends on the type of tumour and its location.
Reconstruction of the defect
Small defects are closed directly. For larger ones, local flaps or skin grafts are used, matched to the colour and thickness of the surrounding skin.
Two-stage treatment
For tumours with ill-defined borders or in critical locations, reconstruction is deferred until histology confirms clear margins. This is not a delay but a safer approach.
Tumours in critical areas
The eyelids, nose, ears and lips require specific planning, because tissue loss in these areas also affects function.
Who it is suitable for
Suitable for
- A histologically confirmed or clinically suspicious skin tumour
- A small sore that does not heal, bleeds from time to time and crusts over
- A growing lump or patch that is changing in appearance
- Recurrence after previous treatment
- Actinic keratoses showing signs of progression
Not suitable, or postponed, in cases of
- Poor general health that rules out surgery — alternatives are discussed
- Very advanced disease, where comprehensive oncological treatment is planned first
- Active infection in the area
- Blood clotting disorders that have not been corrected
Preparation
- Dermatological examination and dermoscopy
- Biopsy if the diagnosis is uncertain
- Imaging if deep involvement is suspected
- Planning the reconstruction together with the extent of the excision
- Stopping blood thinners, as agreed with your doctor
How it is performed
Most operations are performed as day cases under local anaesthesia. For extensive tumours or complex reconstruction, general anaesthesia is used.
The tumour is excised with the planned margins. The specimen is marked and sent for histological examination, which also assesses the margins.
The defect is closed directly, with a local flap or with a skin graft, depending on its size and location.
Recovery
- The first 48 hoursSwelling and mild discomfort. The wound is kept clean and covered.
- The first weekDaily wound care. With a skin graft, particular care is taken with the dressing that holds the graft in place on the wound bed.
- 7–14 daysStitches are removed. The histology result becomes available, including assessment of the margins.
- 1–3 monthsThe scar or graft matures. Its colour gradually blends with the surrounding skin.
- 6–12 months and beyondFinal appearance. Regular follow-up for recurrence and new lesions continues.
Pain and discomfort
Discomfort is moderate and is usually controlled with standard painkillers. After more extensive reconstructions and skin grafts, the first few days are more uncomfortable, mainly because of the firm compression dressing.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Incomplete excision requiring a further operation
- Recurrence of the tumour
- A visible scar, especially after extensive facial defects
- Partial loss of a graft or flap
- Difference in colour and texture of the grafted skin
- Infection
- Impaired function after tumours around the eyelid, nose or lip
- Altered sensation
Results and longevity
When the tumour is removed completely, the outlook for basal cell carcinoma is very good.
Follow-up continues for years. Anyone who has had one skin cancer is at increased risk of developing another — this is the main reason for regular check-ups.
The aesthetic result of facial reconstruction is good, but oncological safety remains the priority. Sometimes this means a larger scar than the patient expected.