You have a biopsy which shows that you have skin cancer (figure 1). Skin cancers enlarge slowly and steadily and can invade neighboring areas, like the eye. They can also spread to distant parts of the body if left untreated. Several weeks ago you had a biopsy done. The purpose of the biopsy was to find out if the growth that you or the doctor found was dangerous. A biopsy does not remove the cancer, it only takes off the very top (like the tip of an iceberg) (figure 2).
Figure 1 – Most of Cancer is Under the Skin Surface.
Figure 2 – The Biopsy Removes Only a Small Portion of the Cancer. After 1-2 Weeks the Skin Grows Over the Cancer.
Sometimes the skin will heal after the biopsy because it grows over the cancer. This does not mean the cancer is gone; it means the cancer is now covered with a blanket of skin. If the cancer is not removed completely it can go deep into the skin and cause great harm.
In order to remove your skin cancer, the doctor will first scrape the area with a spoon-like tool called a curette. The cancerous tissue is very soft, like a bad spot in an apple. The soft cancerous tissue spoons right out. The doctor knows when to stop because normal skin is firm or hard compared to the cancer. Skin cancers are much larger than they appear on the surface of the skin. What one sees on the skin surface is only the tip of the iceberg. It is not uncommon for the hole remaining after skin cancer removal to be the size of a nickel. Some patients have a hole the size of a quarter or larger after the skin cancer is removed.
Figure 3 – After the Cancer is Removed, a Large Hole Remains.
After the doctor has scraped out all of the cancerous tissue, he will cut all around the hole with a margin of normal skin measuring about 1/8 of an inch. The tissue removed will than be sent to a pathologist. The pathologist will look at the edges to make sure the cancer is all out. If the pathologist finds cancer at the edges of the removed skin, the doctor will have to go back one week later and remove more tissue. The chances of needing a second surgery to remove all of the cancer is 1 in 20. There is a 1 in 100 chance of needing three surgeries to remove all of the skin cancer. The doctor may fix the hole right away if it is not too large and a side to side closure can be done, or he may wait one week to fix the hole. The reason for waiting one week is to be sure the cancer is all out before closing the wound. This is especially important when a side to side closure cannot be done because of the location of the wound.
There is no way to remove a skin cancer without leaving a scar. Often the scar can be hidden in your natural skin folds. The most important point about skin cancer is that it needs to be completely removed. Many people have lost ears and eyes because their doctor did not remove the entire tumor and some people have lost their lives. The techniques we use give you a 99% chance of being cured of your cancer. Other dermatologist and doctors often scrape and burn skin cancers which can be done in one visit, but this technique has only a 90-95% cure rate. When skin cancers are not cured they come back more aggressive and more difficult to treat. Every 2 weeks we see a patient that has had a recurrence of a skin cancer and some of these have been over 2 inches in size.
All surgery has risks. The risks of complications are low for skin surgery. All patients will have a scar. You need to be patient because the scar will not have its final appearance for six to twelve months after the surgery. Most patients will have numbness in the area for six months, but this can last up to two years. The risk of infection is low, but studies show that no matter how clean the surgery is, some wounds will get infected. If your wound gets infected, the doctor will put you on an antibiotic for one week. The scar will not heal as well if your wound becomes infected. It is very important that you follow the wound care instructions given to you at the end of surgery. Sometimes a blood clot will form under the skin. It this occurs you will have a hard lump in the area for six to twelve months until your body absorbs it. The only danger from a blood clot under the skin is an increased risk of infection.