Basal Cell Carcinoma (BCC) Treatment in Kent, Surrey, Sussex and London

What happens

The area is numbed with local anaesthetic, so you are awake but should not feel pain. Mr Kumar removes the BCC with a margin of normal-looking skin around it, usually a few millimetres, to make sure the edges are clear. Most procedures take 30 to 90 minutes, and you go home the same day.

Closing the wound

Most wounds are closed directly with stitches. So that the skin lies flat, the wound is shaped as a narrow ellipse, which means the final scar is usually around three times longer than the BCC itself. Mr Kumar lines it up with natural creases where possible. If the wound is too large to close this way, a local flap or skin graft is used instead.

Checking it has all gone

The tissue is sent to the laboratory, where a pathologist confirms the type of BCC and checks that the margins are clear. Results usually take two to three weeks, and Mr Kumar goes through them with you. If any BCC is found at an edge, a small further excision or Mohs surgery may be recommended.

Recovery

• Keep the dressing clean and dry for the first day or two.
• Stitches come out after 5 to 14 days, sooner on the face.
• Avoid heavy exercise or stretching the area while it heals.
• The scar is pink at first and fades over 3 to 12 months.

When is excision a good choice?

Surgical excision suits most BCCs, particularly those with clear edges on the body, arms and legs, and many on the face. It treats the cancer in a single visit and provides a tissue sample to confirm the diagnosis.

How Mohs surgery works

Mohs micrographic surgery is carried out by a specialist Mohs dermatologist under local anaesthetic. The visible BCC is removed with a very thin layer of surrounding skin. While you wait, that layer is processed and examined under the microscope, with every edge checked. If any BCC remains, only that exact area is removed in a further layer, and the process is repeated until the margins are clear.

Why it is used

• It removes as little healthy skin as possible, which matters on the nose, eyelids, lips and ears.
• Every margin is checked on the day, so it has very high cure rates, especially for BCCs that have come back or have unclear edges.
• It is particularly useful for larger BCCs or those with an aggressive growth pattern.

On the day

Because each layer is checked before the next step, Mohs surgery can take several hours, so please plan to be there for most of the day. Bring something to read, and take your usual medication unless you are told otherwise.

Same-day reconstruction

Once the margins are clear, Mr Kumar repairs the wound on the same day. Depending on its size and position, he closes it directly or uses a local flap or skin graft, planning the repair around the natural lines and contours of the face for the most natural result.

Recovery

• Expect some swelling and bruising for the first few days, particularly around the eyes.
• Stitches on the face are usually removed after 5 to 7 days.
• Scars continue to settle and fade for 12 to 18 months.

Local flaps

A local flap moves nearby skin, still attached to its own blood supply, into the wound. Because the skin comes from right next to the wound, it matches the colour, texture and thickness of the surrounding skin very well. This is why flaps are often the first choice on the face, for example on the nose, cheek, lip or forehead.

The skin is advanced, rotated or transposed into place, and the scars are planned to sit in natural creases and lines where possible. The final scar is usually longer than the original wound, but often less noticeable.

Skin grafts

A skin graft is a thin layer of skin taken from another part of the body and placed over the wound, where it picks up a new blood supply over the following week.

• Full-thickness graft: taken from an area with spare skin, such as in front of or behind the ear, the neck or above the collarbone. The donor site is stitched closed. Used for smaller wounds, especially on the face.
• Split-thickness graft: a very thin shaving of skin, usually from the thigh, for larger wounds. The donor site heals like a graze over about two weeks.

Which is right for you?

Mr Kumar chooses the best option based on the size and position of the wound, your skin and your general health, and explains the plan before your operation. Reconstruction is usually done at the same operation as the removal, or on the same day after Mohs surgery.

Recovery

• A padded dressing protects a graft for 5 to 7 days and must be kept dry.
• Stitches are usually removed after 5 to 14 days, depending on the area.
• Swelling and redness settle over several weeks, and scars keep improving for 12 to 18 months.
• Please avoid smoking, which reduces the blood supply and increases the risk of a graft or flap not healing.

Specific risks

These include bleeding, infection, part of a graft or flap not surviving, a difference in colour or contour, a raised or puffy appearance of a flap, and occasionally the need for further treatment such as scar massage, a steroid injection or a minor revision.