Surgical Skin Cancer Management — Maitland

During surgical removal, the skin cancer is excised from the surface right down to the base of the skin, along with a carefully measured safety margin of surrounding normal skin to minimise the chance of recurrence. Safety margins vary depending on the type and anatomical site of the cancer (and can be wider for melanomas).

Once excised, the surgical defect is closed using one of three methods: a simple linear closure, a full-thickness skin graft repair, or a local skin flap repair.

For a standard excision, the incision is shaped as an ellipse (an oval with pointed ends), which allows the surrounding skin edges to be brought together smoothly and closed in a neat straight line with sutures.

Every excised specimen is sent to an accredited pathology laboratory, where a specialist pathologist confirms the diagnosis and checks all outer and deep margins under the microscope (typically taking around 1 week).

Occasionally, microscopic tumour extensions reach the edge of the initial specimen beneath the surface — if this is identified on pathology, a second wider excision may be required to guarantee complete clearance. While a scar is unavoidable whenever skin is excised, our doctors use meticulous plastic and reconstructive suturing techniques to minimise scarring.

When a larger skin cancer or ulcer is removed — or where skin is naturally tight — pulling the wound edges directly together may place excessive strain on the tissue. In these situations, a full-thickness skin graft transfers healthy skin from a looser area of the body (the “donor site”) to cover the surgical defect (the “graft site”) without tension.

• Step-by-Step Procedure: Both the skin cancer site and the donor site are numbed with local anaesthetic. The cancer is excised and sent to pathology (~1 week for results). A matching piece of full-thickness skin is taken from the donor site (which is then stitched closed directly in a straight line) and sutured into the graft site with a protective bolster dressing.
• Healing & “Take”: As new blood vessels grow into the transferred skin over the following weeks, the graft “takes”. Because skin texture and colour vary across the body, a graft may differ slightly in appearance from surrounding skin.
• Lower-Leg & Aftercare Considerations: Grafts leave two scars (donor site and graft site). Careful protection from knocks, bumps, or infection is vital — particularly below the knee (shin and foot), where circulation is slower and healing can take several months.

A skin flap repair closes a surgical defect where linear closure isn’t possible by rotating or advancing looser adjacent skin directly into the gap. Because the moved skin comes from right next to the defect, it provides an excellent match in skin colour and texture.

• Preserved Blood Supply: Under local anaesthetic, the skin cancer is excised and sent to pathology. Planned incisions are then made in the looser neighbouring skin so a section of tissue can be mobilised into the defect while remaining attached at its base (which supplies continuous blood flow to the flap).
• Flap Geometry: Depending on the anatomical site and skin elasticity, flap incisions may heal as a zig-zag line, parallel lines, or a curved/cornered scar. Your doctor will explain the exact flap design prior to your procedure.
• Recovery & Care: Careful post-operative wound care minimises scarring and prevents infection or flap-tip circulation issues (which are more common in smokers, older patients, or areas of tight skin where mild contracture can occasionally occur). Remember that all post-procedure follow-up reviews and complication care at Elixir @ Hunter are bulk billed.