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Surgery of skin cancer (non-melanoma)

For non-melanoma skin cancer, surgery is one of multiple treatment modalities and often the most important. The goal of surgery is to prevent local relapse and further spreading of the disease. The surgical margins may vary depending on cancer type and whether the operation is primary or for a recurrence.

For basal cell carcinoma, nodular and other well-defined lesions, 5 mm margins are sufficient. For multifocal and morphea types of basal cell carcinoma, and relapse after previous treatment, the margins are often increased to 10 mm.

Squamous cell carcinoma has a different growth pattern requiring wider margins. Depending on the localization and type, 10-20 mm margins are recommended.

Merkel cell carcinoma has a great tendency for local relapse and lymph node spreading, due to the tumor's propensity for spreading in the dermal lymphatic pathways. Previous reports have shown an increase in local relapse tendency of up to 70%. Because of this, surgical margins of 20-30 mm are recommended, if possible. Merkel cell carcinoma is sensitive to radiation, and postoperative radiation therapy should be considered to prevent local relapse.  

For Kaposi sarcoma, the use of surgery is only used for limited disease or to reduce the tumor size before radiation therapy.

For skin adnex tumors, a rare type of skin cancer, surgery with adequate margins is the recommended treatment in most cases.

Small excisions and excisions on the trunk can usually be closed with direct suture. For larger excisions where direct closure is difficult or impossible, the surgery is performed by a plastic surgeon. The same applies to tumors in the head/neck area. In these cases, it may be necessary to use skin flap or skin grafting for adequate coverage of the surgical defect.

Metastasis

For metastasis to regional lymph nodes, the surgical treatment is lymph node resection.

For general metastatic disease, surgery is used in some situations for palliative purposes.

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