Introduction
Australia has one of the highest rates of skin cancer in the world, making early diagnosis and treatment critically important. For many patients, especially when cancers occur on the face, nose, ears, or lip, surgical removal must be balanced with preserving both function and appearance.
As a Specialist Plastic Surgeon, I routinely treat patients with skin cancer requiring precise surgical excision and reconstruction. This blog explains what patients need to know about the process — from diagnosis to reconstruction — and how to ensure safe, natural outcomes.
Most Common Types of Skin Cancer Treated with Surgery
✅ Basal Cell Carcinoma (BCC): Most common; slow-growing, low risk of spread; but can invade into deeper tissue causing significant symptoms, if untreated.
✅ Squamous Cell Carcinoma (SCC): May grow faster and carry a risk of spreading, especially in high-risk areas (e.g. T-zone of the face, lips, ears, etc). Head & Neck SCCs should be treated in a more timely fashion.
✅ Melanoma: Less common but significantly more serious; requires wide excision and may involve lymph node surgery or systemic staging scans.
NOTE: There are also other less common types of skin cancers, and it is recommended to have any suspicious skin lesion assessed by experienced medical professionals. A biopsy should be considered for definitive diagnosis if in doubt.
When Should Surgical Treatment be Considered?
Surgical excision is often recommended when:
- The lesion is clinically obvious and discrete, or has been confirmed to be invasive cancer on biopsy
- Histological margin control is important (i.e. ensuring all tumour is removed)
- The lesion is located in a cosmetically sensitive area
- Functional structures (eyelids, nose, lips) are in the proximity or involved
- Non-surgical treatments (e.g. topical chemotherapy creams, freezing with cryotherapy, radiotherapy) are not effective or appropriate
What Happens During Skin Cancer Surgery?
- Excision:
The cancer is surgically removed with a surrounding margin of healthy tissue. The specimen is sent to a pathologist to confirm complete removal. - Margin Assessment:
Sometimes a staged excision or Frozen Section or Mohs surgery may be used for delicate areas requiring high precision, before definitive reconstruction is performed. - Reconstruction:
After tumour removal, the wound may be:- Closed directly (primary closure)
- Repaired with a skin graft (using skin from another area)
- Repaired with a skin flap (utilising nearby tissue for wound repair)
- Occasionally a complex composite defect will require more sophisticated reconstruction or a combination of various reconstructive techniques.
The reconstructive plan depends on the location, size, and depth of the defect, and aims to achieve functional and aesthetic restoration.
Some Common Areas Requiring Complex Reconstruction
- Nose: Requires matching skin texture, colour, and contour
- Eyelids & Lips: Important to maintain function and minimise distortion
- Ears: Reconstruction should aim to preserve natural shape and balance
- Face: Requires careful placement of scars to optimal aesthetic result
- Fingers & Hand: Important to preserve function with range of motion
- Scalp & Lower limb: Often lack skin & soft tissue laxity (i.e. the defect usually cannot be closed primary)
- Near mobile joints: Care balance between wound closure and scar tension
Plastic surgeons are trained to handle these defects with specialised reconstructive techniques.
What to Expect After Surgery
- Stitches are usually removed within 5–7 days for facial wounds – to avoid stitch marks
- Mild swelling and bruising are common but settle with times
- Scar care, sun protection, and long-term skin checks are essential
You should receive a detailed post-operative plan by your surgeon to minimise scarring and monitor healing.
Why Choose a Specialist Plastic Surgeon?
Plastic surgeons have specific advanced training in:
- Precise cancer excision with safety margins
- Advanced flap and graft reconstruction
- Minimising distortion to aesthetic features or functional preservation
✅ Patients with cancers in visible or delicate areas benefit most from a specialist who understands both oncologic safety and cosmetic detail.
Is Skin Cancer Surgery Covered by Medicare?
Yes, most medically necessary skin cancer surgeries and reconstructions are eligible for Medicare rebates, and may also be covered by private health insurance. Your surgeon will explain costs, rebates, and any out-of-pocket expenses during your consultation.
About Dr Paul Cheng
I’m Dr Paul Cheng, FRACS, a Specialist Plastic, Aesthetic & Reconstructive Surgeon based on the Gold Coast and in Ballina, NSW. I have extensive experience in managing skin cancers involving the face, nose, eyelids, ears, scalp, and the rest of the body; with a focus on both oncologic safety and aesthetic restoration.
If you’ve been diagnosed with skin cancer or referred for surgical excision and reconstruction, you can book a consultation or follow me on Instagram @dr.paulcheng for educational updates.