Skin Cancer Surgery. Cost, Price Information and Guide

What is skin cancer?

Before understanding different types of skin cancer, it is useful first to have a look at the layers of the skin and the cells it is made up of.

Layers of the skin

The top layer of the skin is known as the epidermis. There are three main types of skin cells in the epidermis:

Types of skin cancer

Basal Cell Carcinoma (BCC)

As its name suggests, this cancer develops from the basal cells in the epidermis of the skin. It is the most common type of skin cancer in people with fair skin and is more common in those over the age of 75. Typically, a BCC will develop on an area of skin that has had regular exposure to the sun, e.g. the head and neck. Initially, a BCC may have a pink, pearly shine; however, this can vary from patient to patient. The lesion will grow slowly and may crust over. It is rare that a BCC will spread to other parts of the body. If left untreated, however, it may cause damage to local structures as it continues to grow.

Squamous Cell Carcinoma (SCC)

This is a cancer of the keratinocytes, the cells that make up most of the epidermis. It is the second most common skin cancer in people with fair skin and is also more common in older people. It is typical for an SCC to develop on the face, particularly around the ears or lips. This lesion may start as a red or pink crusty area and grow to resemble a wart. Furthermore, the SCC may break down and bleed from time to time. As an SCC grows, it progresses deeper into the skin and can destroy surrounding structures like the ear and the nose. It also has the potential to spread to other parts of the body, particularly the lymph nodes, if not treated in its early stages of growth.

Malignant Melanoma

This type of skin cancer develops from the melanocyte cells found in the epidermis. While it is the least common type of skin cancer, it is also the most serious and the most likely to spread to other parts of the body. A melanoma often resembles a mole, in the beginning, a small patch of dark pigment. It can grow on a normal part of the skin or on an existing mole. It will then usually begin to develop more suspicious characteristics.

Treatment options

Surgical removal is generally the best treatment option for all types of skin cancer. Some of the additional treatment options available for each type of skin cancer can also be found below:

This skin cancer treatment overview page gives a very short introduction to skin cancer treatment. For more information, you can visit the NHS website here.

Why choose to have skin cancer treatment?

Skin cancer is a very serious disease. While severity differs with each type, all forms of skin cancer can cause damage to health if left untreated. Below, is information about each type of cancer and reasons why skin cancer treatment candidates should seek treatment as early as possible.

Basal Cell Carcinoma (BCC)

BCCs are the most common type of skin cancer in people with fair skin. They generally develop on areas of the skin that have had a lot of sun exposure, like the head and neck. They often grow very slowly and rarely spread to other parts of the body. Despite this, however, they can cause extensive damage to surrounding structures, e.g. bones and tissues beneath the skin. To prevent this, it is vital to seek treatment as early as possible. Because they grow slowly and are at low risk of spreading, it is nearly always possible to treat BCCs successfully. If the BCC is not fully removed, it may come back again. So, while there are multiple treatment options available, the best option is usually to surgically cut out the cancerous tissue.

Squamous Cell Carcinoma (SCC)

SCC is the second most common cancer in people with fair skin, and it usually grows on areas of the face such as the lips or ears. Similarly to a BCC, an SCC will cause extensive damage to surrounding structures as it grows wider and deeper into the skin. This may end up causing erosion of bones and tissues beneath the skin. Therefore, it is important to seek treatment early. SCC is more likely to spread to other parts of the body than BCC, in particular to the lymph nodes. When a cancer begins to spread within the body, it becomes harder to treat successfully. Consequently, it is so important to treat SCC as early as possible to prevent spread of the cancer. Surgically cutting out the SCC is the best treatment option.

Malignant Melanoma

This is the least common but most dangerous type of skin cancer. Melanomas can develop anywhere on the skin and can develop quite rapidly. As a melanoma grows deeper into the skin, it is more likely to spread within the body. When a melanoma begins to spread within the body it becomes more difficult to treat and death is a possible outcome. Therefore, urgent removal of the melanoma in its early stages of growth is the best treatment option to eliminate cancer and prevent it from spreading.

How is surgical skin cancer treatment performed?

There are a number of different ways to treat skin cancer. The skin cancer treatment procedure chosen will vary on the basis of which type and stage of skin cancer the patient has. The medical team will discuss the options available and explain which option they think is the most appropriate. Sometimes, the team may be able to remove the skin cancer using a simple procedure at an outpatients appointment. Other times, it may be necessary for a more extensive surgical approach. Consequently, the procedure time will vary.

1. Consent

Before any type of skin cancer treatment, patients will have to give their consent to treatment in writing. The consent form should be read carefully to make sure the procedure and risks are fully understood.

2. Anaesthesia

If the cancer treatment involves any type of surgery, patients will be given an anaesthetic before the procedure. For a simple surgical excision, the surgeon will usually inject a local anaesthetic to numb the treatment area. Patients will therefore be awake for the procedure but will not feel any pain. It will take a few hours after the surgery for the numbness to wear off.

For more extensive surgical treatment, a general anaesthetic may be more appropriate for surgery. In this case, the patient will meet with the anaesthetist, and they will explain how the anaesthetic agent will work. Patients will be asleep for the surgery and will wake up slowly when it is over. They may feel groggy for a few hours after waking up, but this will wear off. Memory and concentration may be affected for one to two days, but this will also resolve.

3. Skin cancer removal

The actual surgical technique used to remove skin cancer will vary depending on the type and stage of the cancer. The surgeon may use one of the following types of skin cancer treatment procedure:

Mohs Micrographic Surgery (MMS)

The Mohs Micrographic surgical technique allows the surgeon to slowly remove layer by layer of skin from the treatment area. They will use a microscope to check if there are any cancerous cells present on the last layer of skin that they remove. They will continue to do this until there are no cancerous cells present on the layer of skin removed. This technique was designed to allow the removal of skin cancer while preserving as much healthy tissue as possible. It is most suitable for use in basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).

Excision

Using a scalpel or a razor, the surgeon will cut or shave the cancerous growth from the skin. There are multiple ways in which the surgeon may do this, including:

Simple excision

The surgeon will use a scalpel to remove cancerous skin growth and a small area of healthy-looking tissue surrounding it. After the procedure, the skin that was removed is sent to a lab to check the grade of the cancer. Depending on the results of this, further treatment may be needed.

Wide excision

The surgeon will use a scalpel to remove the cancerous growth and a wider perimeter of healthy-looking tissue around it. They may also remove a deeper layer of skin than with a simple excision. The surgeon will then send the skin to the lab to check the grade of the cancer. Depending on the results, further treatment may be needed. Surgeons often use this technique to treat malignant melanomas.

Shave excision

The surgeon will use a razor to shave or peel off the cancerous growth. Again, the surgeon will send the skin to the lab to check for the grade of cancer after the procedure. Depending on the results, further treatment may be needed.

4. Closing of Incisions

The surgeon will use stitches to close the wound where possible. In some cases with wide excisions, there may not be enough skin available to close the wound, and reconstructive surgery using a skin graft may be necessary. The surgeon will discuss this before the procedure if they suspect this will be the case. Reconstructive surgery is also a possibility at a later date if patients are unhappy with the appearance of the treatment area after surgery.

5. Return home

Generally, patients will be able to return home soon after the procedure. The treatment area may remain numb for a few hours, but the local anaesthetic effects will wear off with time.

For more extensive skin cancer treatment, an overnight stay in the hospital may be recommended.

What should I expect from my skin cancer treatment consultation?

The skin cancer treatment consultation will involve meeting a specialist surgeon or oncologist to discuss the patient’s condition and potential treatment options. During a skin cancer treatment consultation, the surgeon or oncologist will explain the procedure and any risks and complications it involves. They may ask to see a referral from a specialist healthcare professional.

During this consultation, the oncologist or surgeon may ask a number of questions, including:

• What is your current health like?
• Do you suffer from any other medical conditions?
• Have you had any previous surgeries in the past?
• Do you take any regular medications? (Including prescription, over-the-counter or herbal medications)
• Do you smoke, drink alcohol or use recreational drugs?
• Are you currently using or have you used sunbeds in the past?
• Do you take protective measures when out in the sun? (E.g. using sunscreen or hats)

It is important that patients answer these questions as honestly as possible so that the medical team can make the correct choice about which treatment is best.

Questions to ask during your skin cancer treatment consultation

This consultation is also an excellent time to ask the team any questions about the procedure. It is important to have a good understanding of what the treatment involves, the risk and complications that may arise, and what the recovery will be like. Some questions you may like to ask may include:

• What surgical technique do you think will work best for me?
• Do you think my treatment area will require reconstructive work after the cancer is removed?
• Will my skin cancer come back?
• How can I monitor my skin to check for skin cancers in the future?

What are the main skin cancer treatment risks and complications?

As with any surgery, there are some skin cancer treatment risks and complications to be aware of.

If the treatment plan involves surgical excision, the potential surgical risks include, but are not limited to, the following:

Infection

Every type of surgery carries a risk of infection. The medical and surgical team will do their best to prevent any infections from occurring. If an infection occurs, it will often be a minor wound infection treated with a short course of antibiotics. Infections should not be left untreated as they can spread and become more severe. It is, therefore important to be aware of the signs of infection to know when to seek medical help. These include:

• Redness around the wound that gets worse over time
• Redness that is beginning to spread away from the incision
• Foul-smelling discharge or pus coming from the wound
• A temperature of over 38° C
• Pain that is not relieved by painkillers

Bleeding & Bruising

There may be some minor bleeding from the wound and bruising of the skin around it. This is common. However, in some cases, the bleeding may become more severe, causing blood to collect beneath the skin and clot. The medical name for this is haematoma. If the patient develops a haematoma, further surgery is needed to remove it.

Incomplete excision

Some of the techniques the surgeon can use to remove the skin cancer involve two stages. Firstly, they start by removing the cancerous growth and a margin of healthy-looking tissue around it. Then, they send this skin to a lab after the procedure is complete to detect the presence of cancerous cells in the sample. Because this is done in a two-stage process, there is the risk that they might have left cancerous cells behind on the skin, depending on what the results conclude. If this occurs, further surgery will be necessary to remove the remaining cancerous cells.

General surgical complications

There are general risks that come with all surgeries. These include nausea and vomiting, risks of anaesthesia, post-operative pain and blood clots. To reduce the risks of their occurrence, we advise choosing a qualified, experienced surgeon that you can trust.

Damage to surrounding structures

There is the risk that the surgery may cause damage to structures surrounding the treatment area. For example, nerve or gland damage.

Scarring

Surgical skin cancer treatment techniques often leave scars on the treatment area. In the first few months after the surgery, the scars will be pink and quite obvious. However, with time and a good scar care regimen, the scars will fade.

Recurrence

Unfortunately, there is always a risk that skin cancer may reoccur. It is important to be aware of this and regularly check for any signs of recurrence. The surgeon will state what symptoms to look out for. The surgeon will generally recommend checking the skin once a month. It is also vital to attend any follow-up appointments that the doctor or surgeon scheduled.

How can I prepare for skin cancer treatment?

Preparation is key to ensuring a stress-free, speedy recovery after treatment. Below is a list of some skin cancer treatment preparation tips we hope will help.

Household work

To make life easier for when returning home after surgery, it’s a good idea to either complete some household tasks beforehand or allocate these to another household member. For example, patients may wish to give the house a clean. It is also a good idea to take the rubbish out so patients can avoid having to lift heavy, full bin bags right after the operation.

Shopping

It's recommended that patients do a big food shop a day or two before the operation and stock up on groceries that they will need for the week after surgery. This will mean that patients do not need to make a trip to the supermarket in the early days after the surgery, when they may not feel up to leaving the house.

Young children and pets

If patients have children or pets, they may wish to ask a friend, relative or babysitter to look after them during the recovery period. After surgery, patients may lack their usual energy, so doing this will take some pressure off. This will also allow patients to relax so that they can rest and recover properly fully.

Driving

The effects of a general anaesthetic may leave patients feeling tired and groggy in the hours after the surgery. Therefore for patient safety, they will not be allowed to drive for 24 hours. Arranging for a friend or family member to pick them up at the hospital after the surgery so that they can drive home is a good idea. Depending on how patients feel, they may wish to have them stay over for at least the first night. This is especially important if there is no one else at home. Having a familiar face after an operation will make patients feel more at ease.

Diet

A healthy diet is a very important part of preparing for any surgery. Eating a balanced diet in the weeks before will allow the body to be in a better state for a surgical procedure. Eat lots of nutritious fruit and vegetables, as well as foods high in protein such as chicken, fish or tofu. Keep the intake of caffeine and sugary or salty foods to a minimum, and stay hydrated by drinking plenty of water.

Clothing

Patients may want to choose some pieces of clothing that will be loose and not restrictive around the treatment area.

How can I prevent skin cancer?

Patients cannot always prevent skin cancer from developing. However, they can reduce the risk by taking some precautionary measures, which include:

• Avoiding overexposing skin to UV light
• Protecting skin from the sun by using high-factor sunscreen
• Avoiding getting sunburnt
• Limiting the amount of time spent in the sun
• Avoiding the use of sunbeds and sunlamps
• Regularly checking your skin for signs of skin cancer

More information on how to prevent skin cancer here.

Aftercare

What can I expect after skin cancer treatment?

Knowing what to expect after treatment is an important part of understanding the procedure. The surgeon or oncologist will be able to give specific skin cancer treatment aftercare advice.

After treatment, the medical or surgical team will organise a follow-up appointment to check on the patient’s recovery. If the patient is due to receive results about the skin samples that were sent for lab testing after the treatment, they may get the results at this appointment. In addition, the surgeon will look at the wound site and remove any non-dissolvable stitches.

How will I feel after the treatment?

This will depend on what kind of treatment patients have had. If they have a local anaesthetic agent, they will be awake for the procedure but unable to feel anything in the treatment area. After surgery, they will feel completely normal, apart from some numbness in the treatment area. This will wear off within a few hours. The treatment area may begin to feel painful as the numbness wears off.

If patients are having more extensive skin cancer removal surgery, they may have a general anaesthetic agent. In this case, they will be asleep for the duration of the procedure. They will wake up gradually when the operation is complete and will feel slightly groggy as the anaesthetic wears off. This will only last for a few hours. Patients may notice their memory and concentration are affected for a day or two after surgery. Again, these side effects will wear off with time.

When will I be able to return home after my treatment?

This, again, depends on the type of treatment. For simple surgical excisions, it is likely that patients will be able to go home the same day. However, if the surgeon has to do a more complex surgical excision, they may have to stay in the hospital overnight. This will be discussed during the consultation.

How will I get home after my surgery?

It is advisable to arrange for a family member or a friend to pick patients up from the hospital after treatment. This is to ensure that the patient is safe if they have been given an anaesthetic, but also to make sure they have someone there to look after them after treatment.

If the patient has been given an anaesthetic, they will not be able to drive themselves home straight after the treatment and may not be able to drive for a short period afterwards, depending on their surgeon’s instructions.

When can I return to work?

Most patients are able to return to office work within one to two days after their procedure. This may vary, however, if they have a more physical job which will affect their treatment area. The medical team will be able to give more specific advice on this. Despite returning to work, patients should try to rest as much as possible in the first few days after their surgery.

When can I exercise again?

Patients will be able to return to light activities from 7 to 21 days after their surgery. The surgeon will give a more exact timeframe, as this will depend on the location and size of the treatment area.

How can I prevent the recurrence of skin cancer?

An important aspect of skin cancer treatment aftercare is prevention and monitoring. To prevent further skin cancers from developing, it is vital that patients take the proper precautions when out in the sun. This involves wearing a high SPF sunscreen, wearing a hat which shades the face and neck and avoiding sitting in direct sunlight for prolonged periods of time. It is also vital that patients attend all their regular follow-up appointments. To monitor the skin for the growth of further skin cancers, patients should check their skin regularly for any suspicious changes. The surgeon or oncologist will tell patients how often they will need to do this and when they should seek medical advice.

How should I care for my scars?

The scars may be tender after the stitches are removed. They may appear pink and lumpy. The surgeon may recommend daily scar massage with a scar gel or moisturiser to help smooth out and fade the appearance of the scars. As the scars get less tender, patients may be able to increase the pressure of the massage. It is important to keep the scars out of the sunlight or to use a high-SPF sunscreen on them to avoid discolouration. This will also help patients to avoid developing further skin cancers.

Remember that it is vital that patients follow their specialist oncologist or surgeon’s skin cancer treatment aftercare advice.