Surgery can solve most early-stage skin cancer cases

If you have a spot or ulcer on your skin that looks odd, changes appearance or won’t heal, it may be skin cancer and you should get it checked out. The good news is for most cases, if caught early, a simple surgical removal may be all that’s needed.

According to the Skin Cancer Foundation:

• About one in five Americans will get skin cancer by the time they reach 70. Repeated long or intense exposure to ultraviolet radiation from sunlight and tanning beds gets most of the blame for causing skin cells to grow out of control, resulting in a tumor or lesion.
• The two most common types, basal cell and squamous cell carcinomas, are responsible for 3.6 million and 1.8 million cases, respectively, diagnosed in the U.S. each year.
• The less common and more dangerous melanoma caused an estimated 200,340 cases in 2024, resulting in about 8,200 deaths. A fourth type, Merkel cell, is rare and deadlier, causing about 3,000 cases and 700 fatalities annually.

“We have an aging population, and we have a lot of skin cancer here,” said Lawrence M. Novak, MD, FACS, a general surgeon with Cape Cod Healthcare General and Thoracic Surgery, in Hyannis. People who spend a lot of time outdoors, especially near or on the water, have a high risk from being exposed both to direct sunlight and reflected light, he said.

The Skin Cancer Foundation says other risk factors include:

• Skin type, number of moles and hair color
  • People with lighter-colored skin and light eyes are more at risk, but people with dark skin can get skin cancer, too. People with red hair are also more at risk, as are those with lots of moles, or large or unusual moles.
• Your family genetics
  • About 10 percent of melanoma cases have a close relative with a history of the disease.
• Organ transplant, photosensitivity and immune disorders
  • People who have had an organ transplant are more at risk; anti-rejection drugs may be the reason. Photosensitivity may be caused by some medications and skin products. People with immune disorders or compromised immune systems and some other medical conditions may have increased photosensitivity.

Simple Excision

Two procedures to remove skin cancer are simple excision and Mohs surgery. Dr. Novak said most skin cancer lesions can be dealt with through simple excision, in which skin containing the lesion and about 5-10 millimeters (0.2-0.4 inches) around it are sliced off under local anesthesia, which can be done in his office in about 15 minutes. Any stitches used are absorbable.

The edges, or margins, of most lesions are “fairly obvious,” Dr. Novak said. “Ninety percent of the time, you’re going to get all of it.”

The removed tissue is sent to a pathology lab to confirm if all of the lesion was removed and to characterize the type of cancer.

“If it comes back with positive margins, then you have to come back in” to remove a little more, Dr. Novak said, saying some lesions “grow like starfish” with arms extending into surrounding skin. “We have to go back in and re-excise the scar.”

The results of simple excision are “90 percent locally curative,” he said.

Simple excision is suited to broad areas of skin, including the chest, back, shoulders, arms and legs. Some areas require replacing the removed skin with a skin graft. Dr. Novak said one such location is the shin, a very common area for skin cancer, as people often forget to put sun block there. Skin for the graft may be taken from a spot on the thigh usually covered by clothing to hide the scar.

In patients with melanoma, Dr. Novak said he may take tissue samples, or biopsies, of nearby lymph nodes in addition to excising the tumor to see if cancer cells have spread beyond the original site. These procedures would be done in the hospital with the patient under sedation.

“For melanoma in situ (cancer cells confined to outer layer of skin, or stage 0, according to the American Cancer Society), surgery wouldn’t do lymph nodes,” he said. “It depends on the depth of the biopsy.”

Mohs Surgery

Also performed at Cape Cod Hospital is Mohs surgery, in which a thin layer of skin including the lesion is removed, then examined under a microscope. These steps are repeated until no tumor margins are found. According to the Skin Cancer Foundation, this precise method can be done under local anesthesia, spares more healthy tissue and offers up to 99 percent cure rate for previously untreated skin cancer. The procedure is suited for basal cell and squamous cell carcinomas on the face, hands, toes and genitals, as well as large or aggressive lesions or those with difficult to determine edges, and some melanoma cases.

Dr. Novak said he refers patients in need of Mohs surgery, a subspecialty of dermatology, to a Mohs surgeon.

A Non-Surgical Option

Some squamous and basal cell lesions may be treated without surgery by using superficial radiation therapy, which may be applied in a series of brief sessions. This treatment is also available at Cape Cod Hospital and Falmouth Hospital. The radiation kills the cancer cells, and the area subsequently scabs and then heals. This method may be used for large lesions, those in areas where it’s difficult to remove surgically or for a patient who wants to avoid surgery, according to the American Cancer Society. It can also be used to kill cancer cells left after surgery. However, while superficial radiation therapy may be effective, it cannot be used again if the cancer returns.

Prevention and Early Detection

Want to lower your chances of skin cancer? Avoid sunbathing and tanning salons, use a sun block with an SPF rating of 45 or higher and wear a wide-brimmed hat, UV sunglasses and protective clothing outdoors, Dr. Novak said.

Want to prevent a potential skin cancer lesion from developing into a serious threat? Go see your doctor.

“If you have a suspicious lesion on your body, or a non-healing wound or an ulcer, it needs a biopsy,” Dr. Novak said. The biopsy may be a tissue sample of a bigger lesion or removal of an entire smaller lesion.

“The best treatment is prevention,” he said. If an ulcer or wound “hasn’t healed in a couple of weeks, you should get a biopsy or a referral to a surgeon who can do a biopsy.”