This is the removal of skin lesions — suspicious moles, carcinomas, melanoma and benign tumours — with adequate margins, pathology on everything removed and a closure that looks after the result.
Skin cancer is the most frequent cancer in humans and also the most curable, on one condition: that it is treated in time. In Peru people come late, for two reasons that come up again and again in the consultation. The first is the belief that dark skin does not develop skin cancer, which is false: it develops less often, but it is diagnosed later and so arrives in worse shape. The second is altitude and radiation: Lima, the highlands and the jungle have very high ultraviolet indices, and the accumulated exposure of a working life outdoors is a real factor.
The surgery consists of removing the lesion with a margin of healthy skin around it, the width of which depends on the type of tumour, and closing the defect. That closure may be direct, with a graft or with a flap, according to the size and the area. On the face, where most of these tumours occur, the reconstruction matters: it is possible to remove the tumour well and leave an avoidable deformity, and that is precisely what training in plastic surgery is about.
It usually helps when there is
- A mole that changes in size, shape, colour or borders.
- A lesion that bleeds, ulcerates or does not heal within a month.
- A new lesion in an adult, especially if it is growing.
- An already confirmed diagnosis of basal cell, squamous cell carcinoma or melanoma.
- A benign lesion that is bothersome, gets irritated or causes worry.
Worth discussing first if
- A lesion stable for years with no changes, which may simply be monitored.
- Multiple lesions needing prioritisation and dermatological follow-up.
- Anticoagulation, which must be managed with the treating doctor.
- Active infection in the area, which is treated first.
- An extensive lesion needing planning and perhaps combined treatment.
None of these rules the procedure out on its own; all of them change the conversation.
What type of tumour it is
The type determines the margin needed and the additional tests.
Basal cell carcinoma
The most frequent. It grows locally and practically never spreads, but it destroys tissue if left to progress. It is cured by complete removal.
Squamous cell carcinoma
More aggressive than the above and able to spread. It needs wider margins and sometimes investigation of the lymph nodes in the area.
Melanoma
The least frequent and the most serious. The outlook depends on the thickness at the time of diagnosis, which is why how soon you come matters so much.
Oncology first, the scar afterwards
The order is never reversed. The margin the type of tumour demands is respected even when it forces a more complex closure or a larger scar. Reducing the margin to leave a smaller scar is the surest way for the tumour to recur, and a recurrence forces a second operation larger than the one you were trying to avoid.
Everything removed is sent for pathology, without exception and even when the lesion looks clearly benign. It is the only way to have a certain diagnosis and to confirm that the margins are clear. When the report says a margin is involved, it is widened: it is inconvenient, and it is the right thing to do.
Within that rule, the closure is planned with an eye to appearance: incisions are oriented along the natural lines of the skin, local flaps are used that bring tissue of similar colour and texture, and grafts are kept for when there is no better alternative.
What the process is like
From the first consultation to the pathology result, with the usual timings.
Consultation
The lesion and the rest of the skin are examined, whether it needs a biopsy first or direct removal is decided, and the closure is planned.
Surgery
Almost always as a day case and under local anaesthesia. Removal with the appropriate margin and closure directly, with a graft or with a flap.
Pathology result
In one or two weeks. It confirms the diagnosis and whether the margins came back clear. If they did not, a widening is scheduled.
Follow-up
Periodic checks of the scar and of the rest of the skin. Anyone who has had one skin cancer is at higher risk of another.
What to expect
In most cases it is a short recovery with no downtime.
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Days 1 to 7
A dressing and simple wound care. Mild discomfort. Normal life from the first day in most cases.
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Weeks 1 to 2
Stitches out according to the area: sooner on the face, later on the trunk and limbs. The pathology result arrives.
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Weeks 3 to 12
The scar goes through its red, firm phase. Strict sunscreen over it to stop it pigmenting.
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Months 6 to 12
The scar reaches its final appearance. Skin checks continue.
Risks, and what is not promised
Those of any skin surgery: bleeding, haematoma, infection, breakdown of the suture, a visible or hypertrophic scar, altered sensation in the area and, when a graft is used, a difference in colour and texture from the neighbouring skin.
The specifically oncological risk is recurrence, which depends on the type of tumour and on whether the margins came back clear. That is why the pathology report is part of the treatment and not a formality, and why a widening of margins may be necessary even though the first operation went well.
It is not promised that no scar will be left: removing a tumour always leaves a mark, and on the face it is planned to disguise it, not to avoid it. Nor is it promised that no other tumours will appear; anyone who has had one is at higher risk, hence the follow-up. These risks are reduced by adequate margins, systematic pathology and sun protection. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about skin tumours
When it changes: in size, in shape, in colour, when its borders become irregular, when it bleeds or itches, or when a new one appears in adulthood and grows.
A lesion that does not heal within a month also deserves a look. When in doubt, have it checked: the consultation is quick and the alternative is coming too late.
Yes. It is less frequent, but it happens, and it tends to be diagnosed later precisely because of the belief that it cannot.
In darker skin, melanoma also appears relatively often in areas with little exposure: the soles of the feet, the palms and under the nails. Those areas need looking at too.
Everything, without exception, even when the lesion looks clearly benign. It is the only way to have a certain diagnosis and to confirm the margins are clear.
A procedure that removes a lesion without sending it for pathology is not acceptable, and that includes cauterising or lasering suspicious lesions.
A suspicious lesion, no. Laser or cautery destroy the tissue and make pathology impossible, so the diagnosis is lost and there is no way of knowing whether anything was left behind.
For benign lesions already identified there is more latitude. For any lesion in doubt, it is excised and examined.
Question not answered here? There are more answers in the frequently asked questions.
