Surgical Dermatology

Skin Cancer Surgery in Singapore

Dr. Liew Hui Min

accredited consultant dermatologist

Skin cancer surgery involves the removal of cancerous cells from the skin. This procedure aims to eliminate cancer cells while preserving as much healthy tissue as possible. The surgical approach varies depending on the type, size, and location of the skin cancer, with the primary goal being complete removal of cancerous tissue to reduce the risk of recurrence.

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Skin Cancer Surgery

The following conditions may necessitate skin cancer surgery based on clinical evaluation and diagnostic testing.

Confirmed Diagnosis of Skin Cancer: Surgery is performed when a biopsy confirms the presence of cancerous cells in the skin. The type of cancer determines the specific surgical approach.
Suspicious Lesions: Lesions showing characteristics of potential malignancy, such as asymmetry, border irregularities, colour variations, or changes in size, may require surgical removal for definitive diagnosis and treatment.
Precancerous Growths: Actinic keratoses and other precancerous lesions that show potential for progressing to skin cancer may be surgically removed as a preventive measure.
Recurrent Skin Cancer: Areas where skin cancer has previously been treated and has returned often require additional surgical intervention.

Benefits of Skin Cancer Surgery

Skin cancer surgery performed by a dermatologist provides several advantages for patients dealing with various forms of skin cancer.

Cancer Removal

Surgery physically removes cancerous tissue from the body, addressing the immediate threat and preventing further spread of cancer cells to surrounding tissues.
Definitive Diagnosis

The removed tissue undergoes pathological examination, providing confirmation of cancer type, determining if margins are clear, and guiding decisions about additional treatment if needed.
Reduced Recurrence Risk

Complete surgical removal of cancerous tissue with appropriate margins decreases the likelihood of cancer returning to the same location.
Tissue Preservation

Modern surgical techniques focus on removing cancerous tissue while maintaining as much healthy surrounding tissue as possible, helping preserve function and appearance.

Surgical Techniques

Standard Excision

This technique involves removing the cancerous growth along with a margin of healthy tissue surrounding it. The wound is then closed with sutures after the tumour is removed. Standard excisions are typically performed for well-defined basal cell and squamous cell carcinomas as well as melanomas, with margin width determined by cancer type and depth.

Mohs Micrographic Surgery

This specialised procedure removes skin cancer layer by layer, examining each layer under a microscope until no cancer cells remain. This method preserves the maximum amount of healthy tissue while ensuring complete cancer removal. Mohs surgery is particularly effective for cancers in cosmetically and functionally sensitive areas like the face, hands, and genitals, or for cancers with unclear borders or high recurrence rates.

Curettage and Electrodesiccation

This procedure involves scraping away cancer cells using a curette (a spoon-shaped instrument) and then applying an electric current to destroy any remaining cancer cells and control bleeding. The process may be repeated several times during the same session.

Cryosurgery

This method uses extreme cold, typically liquid nitrogen, to freeze and destroy cancerous tissue. The frozen tissue eventually thaws and sloughs off, allowing healthy skin to grow in its place. Cryosurgery is primarily used for small, thin, superficial skin cancers and precancerous growths, particularly in patients who cannot tolerate other surgical procedures.

Preparing for the Procedure

Medical Evaluation: A comprehensive health assessment helps determine the most appropriate surgical approach. This evaluation may include a review of medical history, current medications, allergies, and previous skin cancer treatments. Imaging studies may be ordered for larger or more complex skin cancers to assess depth and involvement of underlying structures.

Medication Adjustments: Certain medications may need to be temporarily discontinued before surgery to reduce bleeding risk. Blood thinners, aspirin, anti-inflammatory drugs, and some supplements often require adjustment prior to the procedure.

Skin Marking: The surgical site is typically marked while the patient is in a natural position to ensure precise removal. This involves carefully outlining the visible margins of the cancer and the planned excision boundaries.

Fasting Guidelines: Depending on the type of anaesthesia planned, patients may need to avoid eating or drinking for a specified period before surgery. For procedures using local anaesthesia only, fasting is typically not required, while those requiring sedation or general anaesthesia will have specific fasting instructions.

Step-by-Step Procedure

Anaesthesia Administration

The surgical area is numbed with local anaesthesia injected around the cancer site. The anaesthetic medication blocks nerve signals to prevent pain during the procedure. For larger or more complex surgeries, sedation or general anaesthesia may be used.

Surgical Site Preparation

The area is cleansed with an antiseptic solution to reduce the risk of infection. Sterile drapes are placed around the surgical field to maintain a clean environment. The previously marked borders may be reconfirmed at this stage.

Cancer Removal

The cancerous tissue is removed according to the selected surgical technique. For standard excisions, this involves cutting out the cancer and a margin of healthy-appearing tissue. The size of the margin depends on cancer type, size, and location.

Bleeding Control

Small blood vessels encountered during surgery are sealed using electrocautery, pressure, or specialised medications to minimise blood loss. This step ensures a clear surgical field and reduces complications from bleeding after the procedure.

Wound Closure

After cancer removal, the wound is reconstructed to optimise healing and appearance. Simple wounds may be closed with sutures, while larger defects might require skin flaps or grafts to cover the area. The closure technique is selected based on wound size, location, and tissue characteristics.

Post-Surgical Care and Recovery

Wound Care

The surgical site requires proper care to promote healing and prevent infection. This typically involves keeping the area clean and dry for the first 24-48 hours, then following specific cleaning instructions. Dressings may need changing according to a prescribed schedule, and antibiotic ointment might be recommended for certain wounds.
Pain Management

Discomfort after surgery can usually be controlled with prescribed or over-the-counter pain medications. Most patients experience mild to moderate pain that diminishes within a few days after the procedure. Elevating the affected area and applying cold compresses can help reduce swelling and discomfort.
Activity Restrictions

Limiting certain activities helps protect the surgical site during healing. Heavy lifting, vigorous exercise, and activities that stretch or put tension on the wound should be avoided for a specified period. The duration of restrictions varies based on the extent of surgery and the location of the wound.
Follow-up Appointments

Regular check-ups allow for monitoring of the healing process and early detection of any complications. The initial follow-up typically occurs within 1-2 weeks for suture removal and wound assessment. Long-term follow-up visits are scheduled to monitor for cancer recurrence and check for new skin cancers.

Potential Risks and Complications

While skin cancer surgery is generally effective, possible complications include infection at the surgical site, bleeding or haematoma formation, poor wound healing, and scarring. Nerve damage may occur, resulting in numbness, tingling, or weakness in the affected area. Some patients may experience allergic reactions to anaesthetics or other medications used during the procedure. The risk of cancer recurrence exists if microscopic cancer cells remain after surgery. Additional concerns include changes in skin colour at the surgical site and contour irregularities, particularly with larger excisions. These risks vary based on factors including cancer type and location, surgical technique, and individual healing characteristics.

Frequently Asked Questions

How long does recovery take after skin cancer surgery?

Recovery time varies depending on the size and location of the surgery as well as the specific technique used. Most patients can resume light activities within a few days, though complete healing of the surgical site may take several weeks to months. Larger or more complex surgeries typically require longer recovery periods.

Will I have a scar after skin cancer surgery?

The appearance of scars depends on factors including the surgical site, the technique used, individual healing characteristics, and post-operative care. Scars typically fade and become less noticeable over time, with most improvement occurring within the first year after surgery.

What is the risk of skin cancer returning after surgery?

While surgery aims to remove all cancer cells, recurrence remains possible. The risk varies based on cancer type, size, location, and whether clear margins were achieved during surgery. Regular follow-up examinations help detect and address any recurrences early.

Dr Liew Hui Min

Dually Accredited Dermatologist In Singapore and the UK

Dr. Liew Hui Min is an accredited consultant dermatologist from the Ministry of Health and the General Medical Council UK.

Her clinical interest includes:

Paediatric Dermatology,
Women’s Dermatology,
General Adult Dermatology.

Having trained in major London Hospitals, Dr Liew returned to Singapore in 2014 as a Consultant at KK Women’s and Children’s Hospital (KKH) where she specialised in paediatric, women, obstetric and vulva dermatology. Currently, Dr Liew practices at The Skin Drs. clinic located at Gleneagles Hospital.

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