In skin cancer treatment, excising (cutting out) a tumor or precancerous lesion is only one among many surgical options. In some cases, other techniques offer greater precision and/or a faster healing time with less scarring. Mohs surgery is an example of an advanced method of cancer removal for melanoma. It involves shaving off minute layers of skin and inspecting them to find the margins of the tumor without taking more tissue than necessary. Alternative surgical approaches used for other types of skin cancer include:
CO2 and argon surgical lasers are sometimes used for removing skin tumors. The laser can cut the top layers of the skin without damaging underlying or surrounding tissues. In the hands of a skilled dermatological surgeon, the laser is a more precise tool than a scalpel. Some patients experience less bleeding, swelling, and pain after a laser surgery than a traditional surgery. These lasers are not suitable for destroying cancer cells deep in the tissue, so they work best when used on superficial tumors. Close monitoring is required to make sure the cancer doesn’t come back after treatment.
Very small lesions that have not been treated with other therapies may be addressed with a curetting tool. The malignant cells are scraped off the skin. The area is then treated with a cauterizing needle that uses electricity to burn away any remaining tissue that might be cancerous. This process may be repeated several times until the surgeon is reasonably sure that the skin tumor is eliminated. The resulting wound is typically left to heal without sutures.
Cryosurgery is sometimes used for lesions that have not actually reached the cancerous stage. Actinic keratosis is an example of this type of skin lesion that may progress to squamous cell cancer if left untreated. Freezing may also be done with small skin tumors – often in combination with another therapy. It isn’t used for larger tumors or when it may cause distortion in the skin during healing. In this procedure, the treatment area may be numbed with a local anesthetic prior to the application of liquid nitrogen. The freezing nitrogen kills the skin and cancer cells it comes into contact with. These slough off and are replaced with healthy skin. The healing process may be painful and can take up to 6 weeks. However, this option may be the best approach for patients who would bleed excessively during a standard surgery.