Surgical for Skin Cancers

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Early detection and treatment of skin cancer are essential to prevent the disease from spreading and achieve the best possible outcomes. While some low-grade skin cancers can be effectively managed with nonsurgical treatment, others are best treated using a surgical technique. A specialist dermatologist will recommend the best course of action for your circumstances after conducting an examination.

What Is Curettage and Cautery for a Skin Cancer?

Curettage is a procedure performed by a dermatologist under local anaesthetic. Using a spoon-shaped instrument with a loop on the end, the dermatologist scrapes the top layer of skin where the cancerous lesion is present. The area is then cauterised to minimise bleeding and increase the likelihood of successful treatment of the cancer. The wound typically heals within a few weeks, leaving a small scar, and the lesion will be sent to a pathology laboratory for analysis.

What Happens During Surgical Excision of a Skin Cancer?

During surgical excision, the skin cancer is identified and marked out with an excision safety margin. The cancerous lesion and a small amount of the surrounding healthy tissue are excised. The wound is closed, often using a combination of deep dissolvable sutures and nondissolvable sutures, and the excised tissue is sent for evaluation by a pathologist. The deep dissolvable sutures help reduce skin surface tension and scarring.

What Kind of Anaesthetic Will I Need?

Small skin cancers can usually be excised under local anaesthetic in our clinic. It’s normal to feel some anxiety about the procedure. The doctors and nurses are understanding of the emotions associated with surgery and experienced in helping patients relax. A premed may be given to address anxiety if needed. As an alternative, surgical excision can be performed through a hospital under heavier sedation or general anaesthetic.

How Long Will My Surgical Procedure Take?

In general, a surgical procedure to remove a cancerous lesion takes 15-30 minutes. The time involved depends on the number of lesions being treated and the complexity of the procedure. Your dermatologist will advise you about the specifics of your procedure.

How Do I Take Care of the Wound After a Surgical Excision?

Following your surgery, return home and rest. Limit your physical activities – including gym classes, sports, heavy lifting or stretching to reach things – to avoid putting stress on the suture line. If you have had surgery around your mouth, do not consume hot drinks until full sensation has returned around your lips. If you have had surgery around your face, avoid bending to pick things up for the first 48 hours, as this can increase blood flow to your face and cause subsequent bleeding and/or bruising. If you have had surgery on a limb, elevate the limb and rest as much as possible. Care for your dressings as advised by your dermatologist. Contact Northside Dermatology if you have any questions or concerns.

What Can Be Done to Minimise My Surgical Scar?

Patients are often concerned about the scarring associated with a surgical procedure. There are many steps that can be taken to minimise the appearance of your scar:

• Your dermatologic surgeon will generally use deeper dissolvable sutures in addition to surface sutures to reduce tension and scarring
• Taping of the wound will further reduce surface tension and scarring
• Limit physical activities after the procedure to reduce the tension on suture lines
• Follow your dermatologist’s instructions to care for your wound and prevent infection
• Use prescribed topical or oral antibiotics if indicated
• Protect the wound from sun exposure
• Use silicone gel to help regulate collagen synthesis, leading to softer and flatter scars
• In case of hypertrophic scarring, intralesional steroid injections can be used to flatten the scar
• In case of persistent swelling within a skin graft or a skin flap, intralesional steroid injections can be used to reduce tissue swelling
• In case of persistent redness, the scar can be treated with the vascular laser
• Laser or radiofrequency resurfacing devices are sometimes used to blend the scar with the surrounding skin

How Much Will the Procedure Cost?

As a general guide, a quick procedure to remove a cancerous lesion can be under $100 out of pocket. A more extensive procedure can range from $250-$750 out of pocket. We will quote the out of pocket cost before your procedure. If you have concerns about the cost in a private clinic, the doctors who consult at the clinic can refer you to a public hospital that can perform the surgery.

Can I Claim Private Insurance on My Procedures?

Private insurance does not cover healthcare costs outside of the hospital setting.  Your doctor can refer you to a surgeon who operates out of a private hospital for certain skin cancers. However, if your procedure is performed in a private hospital, you will generally be responsible for paying for your insurance excess, your surgeon’s initial consult fee, your surgeon’s gap charge, your anaesthetist’s gap charge and the pathology service gap charge. This can add up to well in excess of the charge in a private clinic. The fees you pay to have the procedure done in a private clinic like Northside Dermatology will count toward your Medicare safety net threshold.

Why Should I Choose a Dermatologist for the Surgical Management of My Skin Cancer?

Dermatologists are highly trained in both the diagnosis of skin cancers and in performing skin surgery. Your specialist dermatologist will carefully assess your skin cancer, taking special note of the margins surrounding the lesion to avoid the excessive removal of healthy tissues and minimise scarring. Accurate assessment of the clinical margin of a skin cancer is critical before surgical management for the best chance of cure. When the margins are not clearly evident, your dermatologist may perform mapping biopsies of your skin cancer to better define the margin before making further recommendations to ensure the best surgical management for you. Your specialist dermatologist will refer you to a MOHS surgeon or a plastic surgeon, and/or a radiation oncologist, in the case of large, ill-defined, recurrent skin cancers or if you require general anaesthetic.

At Northside Dermatology, all dermatologists have extensive experience providing early detection, diagnosis and surgical treatment of skin cancers. Contact Northside Dermatology on 03 8582 8688 to schedule an examination.