Is the procedure painful?

Local anaesthesia makes the procedure painless. In the following days, moderate discomfort is usual and well controlled with simple analgesics.

What happens if the margins are not clear?

The histopathological analysis detects this, and a further operation is then scheduled to complete the excision. This is a known and anticipated situation, which does not call into question the proper course of your care.

Will the scar be visible?

All surgery leaves a scar, but its path is planned from the outset: orientation along natural creases, respect for the aesthetic units of the face, adapted reconstruction techniques. It fades over 6 to 18 months.

Is follow-up needed after the operation?

Yes. In addition to monitoring healing, regular dermatological surveillance of the entire skin is recommended, at a schedule defined with your dermatologist.

Skin carcinoma

Skin carcinomas are the most common skin cancers. In the great majority of cases, their reference treatment is surgical excision: complete removal of the lesion with a margin of healthy skin, followed by analysis under the microscope. Diagnosed and operated on early, most carcinomas are treated very successfully.

Pr Ignacio Garrido operates as a surgeon, in coordination with your dermatologist: the latter detects the lesion and establishes the indication; surgical management — excision, reconstruction, scar follow-up — is then carried out in the operating theatre. This information is provided for general guidance and does not replace a medical consultation.

The two main types of carcinoma

Basal cell carcinoma is the most common. It develops slowly, locally, and only exceptionally metastasises. Its treatment is primarily surgical.
Squamous cell carcinoma is rarer and may, in certain cases, spread beyond the skin. Its excision follows stricter margins and warrants closer surveillance.

The exact type, often suspected by the dermatologist and sometimes confirmed by a prior biopsy, determines the excision margins and follow-up.

The principle: excision with safety margins

The objective of the procedure is to remove the entire lesion with a margin of healthy tissue around it, defined according to current guidelines based on the type of carcinoma, its size and its location.

The removed specimen is systematically sent to the histopathology laboratory. The analysis confirms the diagnosis and verifies that the margins are clear. If they are not, a further operation may be necessary: this is an anticipated situation, part of the safety logic of this treatment.

Reconstruction

Depending on the size of the lesion and its location — particularly on the face — closure may be achieved:

by direct suture, the simplest solution when the skin allows it;
by local flap: neighbouring skin is mobilised to fill the defect while respecting the aesthetic units of the face;
by skin graft, taken from a discreet area, when the defect cannot be closed otherwise.

This is where the plastic surgeon's experience comes into its own: treating the lesion completely while preserving appearance as much as possible, particularly on the face.

The procedure

Beforehand: consultation with your dermatologist's report (and the biopsy if one was performed), examination of the lesion, information on the planned margins and the method of reconstruction.
The procedure is most often performed under local anaesthesia, as day surgery. Deeper anaesthesia may be discussed depending on the location and extent.
The duration varies from 30 minutes to over an hour depending on the reconstruction required.

Recovery and healing

Recovery is generally straightforward: dressings for one to two weeks, sutures removed or dissolvable depending on the area, moderate discomfort. The scar evolves over several months and gradually fades; rigorous sun protection of the area is essential for the first year. If a scar remains bothersome later on, a scar revision or laser treatment can be discussed.

Follow-up

After a carcinoma, regular dermatological surveillance is recommended: skin that has developed a first carcinoma may develop others. Self-monitoring (any new lesion, or one that changes, bleeds or fails to heal, should prompt a consultation) and photoprotection are its two pillars.

Skin carcinoma