What is skin tumour surgery?
Skin tumours are the most widespread neoplasms in the population, particularly in people with fair skin, a history of intense sun exposure or a family history of these conditions. Although the diagnosis may cause alarm, the great majority of skin tumours — when identified early — can be treated successfully with surgery, with very high cure rates.
The three main skin tumours requiring a surgical approach are:
- Basal cell carcinoma (BCC): the most frequent, originating from the deep layers of the epidermis. It grows slowly and rarely metastasises, but can cause significant local damage if not treated promptly. It often appears as a pearly or ulcerated lesion, typically on the face, neck or sun-exposed areas.
- Squamous cell carcinoma (SCC): originating from the keratinocytes of the spinous layer of the epidermis. It behaves more aggressively than basal cell carcinoma and has a greater potential to metastasise to regional lymph nodes. It often presents as a keratotic plaque or an ulcer with irregular margins.
- Melanoma: the most dangerous skin tumour, originating from melanocytes. Although less frequent, it has the greatest metastatic capacity and requires prompt excision with wide margins. Early diagnosis is decisive for the prognosis.
Alongside these three main forms, the plastic surgeon also treats other skin neoformations such as dermatofibromas, keratoacanthomas, dysplastic naevi, lipomas, epidermoid cysts and various lesions which, although not always malignant, require correct removal both for oncological safety and for aesthetic reasons.
The added value of the plastic surgeon in this context lies in a double competence: oncological, to guarantee adequate excision margins and reduce the risk of recurrence, and aesthetic, to plan the reconstruction of the treated area so as to obtain aesthetically acceptable results, especially in visible areas such as the face, ears, nose and neck.
Who is the ideal candidate?
Anyone who receives a diagnosis — or a diagnostic suspicion — of a skin tumour is a candidate for surgery. The indication is generally given by the dermatologist, who refers the patient to the plastic surgeon for the management of the excision and reconstruction. Lesions of uncertain nature, but with atypical dermoscopic features, can also be treated surgically for histological confirmation and prevention.
How the operation is performed
The clinical pathway begins with a specialist visit during which Dr. Galati examines the lesion, assesses the dermoscopy, discusses the patient's clinical history and, where necessary, plans a preliminary incisional or excisional biopsy to obtain histological confirmation before the definitive operation.
Pre-operative phase
Before the operation, standard blood tests are carried out and, in the case of melanoma, any staging investigations (lymph node ultrasound, PET/CT) are performed in coordination with the oncology team. The surgeon explains the available reconstructive options to the patient and plans the operation taking into account the anatomical site, the size of the lesion and individual aesthetic needs.
The surgical technique
The operation is performed under local anaesthesia (for small, superficial lesions) or under general anaesthesia/sedation (for extensive or deep lesions, or those in complex sites). The main phases are:
- Excision with oncological margins: the lesion is removed together with a margin of surrounding healthy tissue that varies according to the type and stage of the tumour. For BCC the standard margins are 3–5 mm; for SCC 5–10 mm; for melanoma the margins range from 1 to 2 cm depending on Breslow thickness.
- Intraoperative histological examination: in selected cases, the excised tissue is sent immediately to the pathologist for real-time assessment of the margins, reducing the risk of a repeat operation.
- Reconstruction of the area: once clear margins are confirmed, the surgeon proceeds with the reconstruction. Options include direct suture for small defects, local advancement or rotation flaps for medium-sized defects, and distant flaps or split- or full-thickness skin grafts for more extensive defects.
The choice of reconstructive technique depends on the anatomical site, the size of the residual defect, the quality and laxity of the surrounding skin and the patient's aesthetic expectations. Dr. Galati always favours solutions that respect the aesthetic units of the face and follow the natural tension lines of the skin, to optimise the final result.
Sentinel lymph node biopsy
For melanomas thicker than 0.8 mm (according to international guidelines), a sentinel lymph node biopsy is proposed. This procedure, performed in combination with the excision of the melanoma, makes it possible to assess whether the tumour has spread to the regional lymph nodes, providing fundamental prognostic information and guiding subsequent treatment decisions.
Recovery and results
The post-operative course depends on the extent of the operation. After simple excisions with direct suture, the patient can return to normal daily activities within 24–48 hours, with the sole recommendation of avoiding intense physical exertion and direct sun exposure on the operated area. Lesions on the face require a few additional days of relative rest to allow optimal reduction of post-operative swelling.
Wound care
In the first weeks it is essential to keep the wound clean and protected according to the instructions received. Sutures are generally removed between day 7 and day 14, depending on the site. Until the scar has fully matured (which can take 12–18 months), a high-factor sunscreen (SPF 50+) must be applied whenever the area is exposed to sunlight, to prevent hyperpigmentation of the scar.
Quality of the aesthetic results
Thanks to reconstructive plastic surgery techniques, aesthetic results are generally very satisfactory, even in the case of wide excisions in delicate areas such as the nose, eyelids or ear. The healing and scar-remodelling process is progressive: in the first weeks the scar may appear red and raised, then lightens and flattens over the following months. In selected cases, complementary treatments such as CO2 laser, cortisone injections or compression therapy can be used to further optimise the result.
Oncological follow-up
After the removal of a skin tumour, the patient enters a personalised surveillance programme with periodic dermatological checks for the prevention of recurrences and the early identification of any new lesions. The frequency of the checks (every 3, 6 or 12 months) is established according to the type of tumour, the stage and the patient's individual risk profile.
Frequently asked questions
Skin tumours requiring surgery are identified through a dermatological visit and dermoscopic examination. The ABCDE rule helps recognise suspicious lesions: Asymmetry, irregular Borders, uneven Colour, Diameter over 6 mm, Evolution over time. Any lesion that changes appearance, bleeds or does not heal should be assessed by a specialist promptly. The definitive diagnosis is obtained through histological examination of the excised tissue. In case of doubt, Dr. Galati can perform a preliminary biopsy under local anaesthesia to obtain diagnostic confirmation before proceeding with the definitive excision.
Every surgical procedure leaves a scar, but the plastic surgeon has advanced techniques to minimise its visibility. Through the use of local flaps, intradermal sutures and targeted reconstruction techniques, scars are positioned along the natural tension lines of the skin (Langer's lines) and within the aesthetic units of the face. The final quality of the scar also depends on the anatomical site, the size of the excised lesion and the patient's skin type. Post-operative follow-up includes specific protocols — including topical silicone, sun protection and, if necessary, laser treatments — to optimise the aesthetic outcome of scarring.
Basal cell carcinoma (BCC) is the most common skin tumour: it grows slowly and rarely metastasises, but must be removed completely to avoid local recurrences that can become difficult to manage. Squamous cell carcinoma (SCC) has a greater metastatic potential and requires wider excision margins and closer follow-up. Melanoma is the most aggressive of the three: it originates from melanocytes and can metastasise even at an early stage; its timely diagnosis and removal are decisive for the prognosis. In all three cases, reconstructive plastic surgery makes it possible to manage both the oncological and aesthetic aspects of treatment in the best way.
Recovery varies according to the extent of the operation and the reconstructive technique used. After simple excisions with direct suture, the patient can return to daily activities the following day, with the recommendation of avoiding intense exertion for about 2 weeks. More complex procedures involving flaps or skin grafts require a recovery of 3–4 weeks, during which greater attention must be paid to dressings and post-operative checks. Sutures are removed between day 7 and day 14 depending on the site. Sun protection of the treated area is essential in the first 12 months to prevent discolouration of the scar.
After removal, the excised tissue is analysed histologically to confirm the diagnosis and verify that the margins are clear. The patient then enters a personalised oncological surveillance programme with periodic dermatological checks (every 3, 6 or 12 months depending on the type of tumour and individual risk profile), aimed at preventing recurrences and identifying any new lesions early.