surgery

Surgery (cutting out the cancer) is the first choice of treatment. If treated early, and fully cut out, more than 90% of patients can be cured by surgery.

Careful examination of the tumour and surrounding tissue removed during the operation will help your doctors to decide whether to recommend any additional treatment.

You will meet the surgeon before your operation, so ask him or her to explain what will happen. She or he will also explain the possible complications that can happen following the chosen operation. Click here to find a link to a list of questions you might like to ask your surgeon.

Curettage and Cautery
This method may occasionally be used to treat small, uncomplicated SCCs. It is done under local anaesthetic. A spoon-shaped instrument with a sharp edge (a curette) is used to scrape away the SCC. The wound is then heat-sealed (cauterised). Three treatment sessions are normally required. It may leave a light scar.

Surgical excision
The standard treatment for a SCC is surgery to cut it out along with some of the surrounding normal skin. It is performed under local anaesthetic. You will be given an injection to numb only the area of operation. On small wounds, stitches will be removed after a few days. For wounds on thicker skin, such as on the back, they may be left in for up to two weeks.

Mohs’ micrographic surgery
In some cases a special type of surgery, called Mohs’ micrographic surgery may be used if simple surgery is not suitable. The obvious tumour is first removed by excision, or sometimes curettage. Then, after you have had a local anaesthetic, layers of skin are taken off around the tumour one layer at a time. Each piece removed is then examined in its entirety under a microscope, to see whether there are still cancer cells present at any point. This is done in order to ensure that all of the tumour is removed and to conserve as much healthy tissue as possible, and so minimise the size of the defect. Repair of the effect may require a skin graft or skin flap.

It is most often used for ill-defined tumours and to treat a squamous cell cancer that has recurred in an area near to where it first occurred, particularly when the cosmetic look is important - on the face, or some areas of the head and neck.

It is usually done as an outpatient case.

Skin grafts and skin flaps
If SCC excision or removal leaves a significant wound, or it is in a highly visible place, such as the face, a small skin graft or skin flap (plastic surgery) may be needed to improve the look.

For a graft, a thin layer of healthy skin is taken from another part of the body. To get the best colour match, skin is usually taken from behind the ear for a face graft. For a graft for other areas of the body, skin is taken from somewhere that is usually hidden, such as the inner thigh area. The two areas involved in the graft will look unattractive to begin with. Within a week or two they will have healed and the scars begun to fade.

In some cases, a general anaesthetic is needed. With smaller operations you may be able to go home the same day. Some patients will need to stay in hospital for up to five days while the grafted skin sticks and heals.

For a flap, a slightly thicker layer of skin, including blood vessels, is cut from skin next to the SCC wound, and moved to cover the wound. It is usually all done under local anaesthetic as part of the same surgical procedure.

Cryosurgery
Cryosurgery is rarely used, and only for small, uncomplicated SCCs. A very cold substance (usually liquid nitrogen) is used to freeze off the SCC.

You will be treated as a day-patient, and you will be able to go home the same day.

When the liquid nitrogen is sprayed on to the affected area you may feel a painful stinging sensation. Afterwards it may feel like a burn. A day or two later the skin may blister. It may be a blood blister. This may need draining, but the top of the blister should not be broken. It will need to be covered with a dressing until a scab has grown. After about a month, the scab will drop off, and you may have a white scar.

You will have a follow-up visit about 6-8 weeks later to check that the treatment has been effective. In some cases the treatment may need to be repeated.

Additional surgery
Removing the lymph glands
A very small number of people with squamous cell cancer may need surgery to remove nearby lymph glands. This is called a lymphadenectomy. It is usually only done if there are suspicious bumps or swelling in the lymph glands, and it may be done at the time of surgery to the primary SCC or at a later stage if suspicious glands are found during follow-up. It is quite a big operation and you will need a general anaesthetic.

Lymph glands are arranged in groups around the body, especially at the neck, armpits and groin. Your surgeon will remove the group closest to your tumour.

You will be admitted to hospital one day before the operation, to allow for preparation. Following the operation you will have tubes fitted to allow fluid to drain from the wound. You will spend several days recovering in hospital afterwards. How long depends on how long the tubes for draining the wound must be left in. You may have some pain, for which you will be given pain-killers.

There are common side-effects when lymph glands are removed. They include swelling due to a build up of lymph fluid, called lymphoedema, stiffness, and sometimes pain in the limb closest to the site of the operation. Your medical team will tell you how the side-effects can be controlled, and refer you to the Lymphoedema Clinic for ongoing help.

Preparing for a general anaesthetic
If you need a general anaesthetic, your fitness will be tested, usually by a nurse specialist at a pre-assessment clinic. An appointment will be arranged with you before the planned date for your surgery. You will be asked about your general health, about any breathing or chest problems you have, about any medicines or supplements you are taking, and about allergies. A blood sample may be taken. Your pulse and heart-rate may be monitored. You will not be asked to do exercises.

After treatment
After treatment you should be given clear, written instructions about the care of your wound, and what the arrangements are if stitches need to be removed. You should also be given follow-up information, with a contact telephone number in the appropriate specialist department, for your further information or assistance.

For more general information about surgery click here to go to our treatments section.