Surgery is appropriate for patients with a confirmed or suspected diagnosis of BCC, SCC or melanoma who require excision, as well as patients with lesions suspicious for malignancy awaiting biopsy, patients who have had incomplete or recurrent excisions, and patients requiring reconstruction following previous skin cancer treatment. GPs often treat many forms of skin cancer, as do dermatologists. Your GP will advise you if referral to a Plastic and Reconstructive Surgeon is required.

The extent of surgery depends on the type, size, location and stage of the skin cancer. Dr Alex Cameron will plan your surgery carefully based on your pathology, imaging findings and individual anatomy.

Excision margins refer to the amount of healthy tissue removed around the visible tumour edge. Adequate margins are critical to ensuring complete removal and reducing the risk of recurrence. Margin requirements differ depending on cancer type and risk profile:

• Low-risk BCCs typically require margins of 3–4mm.
• Higher-risk BCCs and SCCs may require wider margins of 5–10mm or more.
• Invasive melanomas require wider margins of 1–2cm depending on Breslow thickness, in accordance with current Australian and New Zealand guidelines.

Sentinel lymph node biopsy (SLNB) may be recommended for melanomas of intermediate or high risk thickness (generally 0.8mm or greater). This procedure involves injecting a tracer dye near the tumour site to identify and sample the first lymph node(s) draining that area. A positive sentinel node indicates microscopic spread to the lymphatic system and guides further treatment, which may include immunotherapy, targeted therapy or further surgery. SLNB is typically performed at the same time as wide local excision of the melanoma.

Reconstruction following skin cancer excision ranges from simple direct closure to complex microsurgical reconstruction, depending on the size and location of the defect:

• Direct closure — small defects in areas of tissue laxity can often be closed directly with fine sutures, leaving a linear scar.
• Local flap — nearby skin and soft tissue is rearranged to cover the defect, preserving tissue colour and texture match. Common designs include rotational, advancement and transposition flaps.
• Skin graft — a thin layer of skin taken from a donor site (such as behind the ear, upper arm or thigh) is transferred to cover the defect. Skin grafts are well suited to larger defects or areas where flap coverage is not possible, but require a separate donor site scar and may not match the surrounding skin exactly.
• Locoregional flap — larger flaps using tissue from adjacent or regional areas of the body can cover more substantial defects, particularly on the face, scalp, neck or trunk.
• Microsurgical (free flap) reconstruction — for the largest or most complex defects, tissue from a distant donor site (such as the thigh, abdomen or forearm) can be transferred using microsurgical techniques, reconnecting the blood supply under the operating microscope. This approach is reserved for defects that cannot be adequately covered by simpler methods.

Surgery is performed under local anaesthetic for smaller, straightforward excisions, or under general anaesthetic for larger excisions, complex reconstructions, or sentinel lymph node biopsy. Procedures may be performed as a day case or may require an overnight or multi-day hospital stay.

Dr Cameron performs skin cancer surgery at Burnside Hospital, St Andrew’s Hospital or Glenelg Community Hospital.

The primary goal of skin cancer surgery is complete removal of the cancer with clear margins. For the majority of BCCs and low-risk SCCs, surgery is highly curative.

For higher-risk SCCs and melanomas, complete excision is the essential first step, but ongoing surveillance and sometimes additional treatment are required as part of a broader management plan coordinated with your oncology team.

Reconstruction aims to restore appearance and function while minimising the visual impact of surgery. Results depend on the size and location of the excision, the reconstructive technique used, your skin type and healing characteristics.

Recovery depends on the complexity of surgery performed. Simple excisions under local anaesthetic typically involve minimal downtime and most patients return to normal activities within a few days.

More complex reconstruction under general anaesthetic follows a recovery course similar to other plastic surgical procedures, with swelling, bruising and discomfort in the first one to two weeks, and gradual improvement over the following weeks to months.

Scars continue to mature over twelve months. We will guide you through scar care throughout your recovery.

Follow-up appointments are scheduled to monitor wound healing and scar maturation, and to ensure ongoing skin surveillance appropriate to your cancer diagnosis.

All surgery carries some degree of risk. These risks are reduced through careful planning, surgical technique and post-operative care.

Risks specific to skin cancer surgery may include:

• Incomplete excision or recurrence. If excision margins are not clear, further surgery may be required. Regular skin surveillance following treatment is recommended for all skin cancer patients.
• Scarring. All excisions leave a scar. Scar appearance depends on location, closure technique, skin type and individual healing. Scars generally continue to improve over twelve months.
• Wound healing problems. Delayed healing may occur, particularly in smokers, patients on immunosuppressive medications, patients with diabetes or those with previous radiation to the area.
• Infection. Wound infection may require antibiotics or further treatment.

Risks specific to skin cancer surgery may include: (cont.)

• Altered sensation. Numbness or altered sensation around the excision site is common and usually improves over time, although permanent changes can occasionally occur.
• Flap or graft complications. These may include partial graft failure, flap necrosis, donor site complications or colour and texture mismatch.
• Sentinel node biopsy complications. These may include seroma, wound healing issues, temporary shoulder discomfort and, rarely, lymphoedema.
• Spread of disease. For higher-risk SCCs and melanomas, lymph node involvement or distant spread may be identified at the time of surgery or on follow-up imaging, requiring further oncological treatment.