Surgical Management of Skin Tumours: A Multidisciplinary and Reconstructive Approach


Skin cancer is the most common malignancy globally, with cases on the rise due to sun exposure, aging populations, and heightened awareness leading to early detection. While early-stage tumours may be treated with simple excision, advanced or high-risk lesions often require coordinated, multidisciplinary care.

Understanding Skin Tumours

Skin tumours may be benign or malignant. The most common types of malignant skin tumours include:

  • Basal Cell Carcinoma (BCC) – slow-growing, rarely metastasises
  • Squamous Cell Carcinoma (SCC) – may be locally aggressive with metastatic potential
  • Melanoma – the most aggressive type, requiring early and definitive intervention

Early detection and a tailored treatment plan are essential to achieving the best oncological and aesthetic outcomes.

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Surgical Management of Skin Tumours

Preoperative Workup and Assessment

Before any surgical intervention, a thorough preoperative evaluation is required to guide treatment planning:

  1. Clinical Examination
    • Assess the characteristics and extent of the lesion
    • Evaluate involvement of critical anatomical structures (e.g., eyelids, nose, ears)
  2. Biopsy and Histopathology
    • Confirms diagnosis and type of skin cancer
  3. Imaging (if indicated)
    • Ultrasound, CT, or MRI for deep or infiltrative lesions
    • PET-CT for high-risk melanoma or suspected metastases
  4. Multidisciplinary Discussion
    • Complex cases are reviewed in a tumour board involving dermatologists, radiation oncologists, medical oncologists and plastic surgeons to decide the best treatment option
Non invasive/ Minimally invasive aesthetic treatment

Treatment Options for Skin Tumours

Wide excision with margins

For many low- to moderate-risk lesions, surgical excision with appropriate margins remains the gold standard. Margins are sent for histological evaluation to confirm complete tumour removal.

Mohs Micrographic Surgery

Mohs surgery, typically performed by dermatologists, is a tissue-sparing technique that offers:

  • Real-time microscopic margin control
  • High cure rates (up to 99% for BCC and SCC)
  • Minimal tissue loss, ideal for cosmetically sensitive areas (e.g., nose, lips, eyelids)

This is especially suitable for recurrent tumours, tumours with ill-defined margins, or those located in functionally or aesthetically sensitive regions.

Non invasive/ Minimally invasive aesthetic treatment

Role of Multidisciplinary Management

Dermatologists

  • Perform diagnosis, biopsies, and may offer Mohs surgery
  • Monitor for recurrence post-treatment

Plastic Surgeons

  • Perform excision for large or complex tumours
  • Offer reconstructive expertise post-tumour clearance, especially in challenging anatomical areas

Radiation Oncologists & Medical Oncologists

  • May offer adjuvant radiotherapy or an alternative treatment option in selected cases.

This collaborative care model ensures optimal outcomes—balancing tumour clearance, aesthetic restoration, and quality of life.

Non invasive/ Minimally invasive aesthetic treatment

Reconstruction After Tumour Excision

After tumour removal reconstruction is tailored to the patient’s needs and the defect’s characteristics.

Reconstructive Options Include:

  1. Primary or Direct Closure
  2. Local Flap Reconstruction
    Uses adjacent skin to cover the defect while maintaining texture and color match—ideal for the face
  3. Skin Grafting
    Harvests skin from another body area; used when primary closure or flaps aren’t suitable
  4. Regional or Free Flaps
    Required for large, deep, or complex defects, particularly when critical structures are involved
  5. Staged Reconstruction
    Multiple surgeries may be planned to refine cosmetic outcome and functional restoration.

Plastic surgeons are uniquely trained to balance oncological safety with cosmetic and functional reconstruction, especially in the head and neck region.

Non invasive/ Minimally invasive aesthetic treatment

Recovery and Follow-Up

  • Recovery time varies from 1–4 weeks depending on the complexity of reconstruction
  • Postoperative care includes wound management, sun protection, and scar optimisation
  • Long-term surveillance is vital, especially for patients with a history of skin cancer

Non invasive/ Minimally invasive aesthetic treatment Risks and Complications

Potential risks of surgery include:

  • Infection or bleeding
  • Scarring or wound breakdown
  • Flap or graft failure (rare)
  • Tumour recurrence

      • These risks are minimised with meticulous technique, appropriate reconstruction, and follow-up care.

Why Choose a Plastic Surgeon for Skin Tumour Reconstruction?

Plastic surgeons bring a unique skill set that blends oncologic safety with artful restoration. We focus on:

  • Precise tumour clearance
  • Natural-looking results
  • Function-preserving techniques for delicate areas like the eyes, nose, and lips

At our clinic, together with the Mohs Surgeons at The Dermatology Practice we are also uniquely positioned to provide comprehensive care of patients requiring both Mohs surgery and reconstruction. We are able to offer combined consultations and perform both the resection and reconstruction in the same setting.

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Frequently Asked Questions

Mohs surgery offers the highest cure rates while sparing the most healthy tissue, making it ideal for sensitive or visible areas.

Recurrent tumours may require wider excision, Mohs surgery, or adjuvant radiotherapy. A multidisciplinary approach is key to planning further treatment.

In most cases, yes. However, delayed reconstruction may be considered in infected wounds or when further margin assessment is required.

Yes. Lifelong surveillance is important as patients who develop one skin cancer are at increased risk of developing others.