Facial skin cancer surgery (Surgical excision and reconstruction of facial skin cancer)
An operation to remove a skin cancer from the face with a clear margin of healthy tissue, and to repair the wound, while keeping appearance and function as good as possible.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- The goal is to remove the cancer completely with a clear margin, confirmed by the laboratory — not just to take away what is visible.
- Surgery often controls non-melanoma skin cancers well, but no treatment can guarantee a cancer will never return, so skin checks continue afterwards.
- On the face, surgeons balance full removal against appearance and function, so a flap or graft repair is often needed and scarring is part of the trade-off.
- Higher-risk or facial cancers are usually planned with a skin cancer multidisciplinary team, and Mohs surgery may be advised for certain sites.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Removes the cancer with the aim of clear margins
A skin cancer better treated another way, such as radiotherapy for certain sites or in people unfit for surgery.
Keep the dressing dry and your head a little raised to limit swelling. Expect bruising and swelling, particularly near the eyes, and use simple...
Clear written wound-care instructions and a named contact for problems.
Keep the dressing dry and your head a little raised to limit swelling. Expect bruising and swelling, particularly...
The wound is checked or dressings changed as instructed. Non-dissolvable stitches on the face are often removed...
Redness, swelling and bruising settle. Many people are back to normal activities, avoiding heavy exercise and...
The scar continues to soften and fade and sensation gradually returns. Sun protection helps the scar settle.
What is facial skin cancer surgery?
Facial skin cancer surgery removes a skin cancer from the face along with a margin of normal-looking skin around and beneath it, to give the best chance that all the cancer has been taken away. The two most common types treated this way are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), together called non-melanoma skin cancers.
The face is delicate, so surgery has to balance removing enough tissue with protecting how you look and how parts like the eyelids, nose and lips work. The gap left after removal may close with stitches, or need a skin flap (nearby skin moved across) or a skin graft (skin borrowed from elsewhere).
The aim is complete removal with clear margins, confirmed by the laboratory. Surgery often controls these cancers well, but no operation can promise that a cancer will never come back, and some people need further treatment or ongoing skin checks. Decisions about higher-risk cancers are usually made with a skin cancer multidisciplinary team (MDT).
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Standard surgical excision
The cancer is cut out with a measured margin of normal skin and sent to the laboratory, which checks afterwards whether the edges are clear. The most common approach for...
Mohs micrographic surgery
The cancer is removed in thin layers and each layer is checked under the microscope during the appointment, so the surgeon keeps going until the margins are clear. It spares...
Reconstruction after removal
Once the cancer is out, the wound is repaired by direct stitching, a local skin flap, or a skin graft, chosen to protect appearance and the function of nearby structures.
Other treatments where surgery is not first choice
Some skin cancers may instead be treated with radiotherapy, curettage and cautery, cryotherapy or creams. Your team will explain when these are appropriate.
Preparing for your surgery
- Make sure the diagnosis and plan have been discussed, ideally with a skin cancer multidisciplinary team for facial or higher-risk cancers.
- Tell your surgeon about all medicines, especially blood thinners, and any drugs that affect your immune system.
- Mention pacemakers or implants, as these can affect the equipment used to stop bleeding.
- Stop smoking if you can, as it slows wound healing and can affect flaps and grafts.
- Arrange a lift home and time off, particularly if a flap or graft or sedation is planned.
- Ask whether the repair will be done the same day or after the margins are confirmed.
- Plan for a dressing on your face and, for grafts, a second wound where the skin is taken from.
What happens
Most facial skin cancer surgery is done under local anaesthetic, so the area is numbed and you stay awake; sedation or a general anaesthetic is sometimes used for larger or more complex operations. The surgeon marks the planned margin around the cancer and removes it, often as an ellipse of skin.
With standard excision, the wound is usually repaired the same day and the removed tissue is sent to the laboratory, which reports a few days to weeks later on whether the margins are clear. With Mohs surgery, the surgeon checks each layer under the microscope during the appointment and removes more only where cancer remains, before repairing the wound once the margins are clear.
Depending on the size and site, the wound is closed with stitches, a local flap or a skin graft. You usually go home the same day with a dressing and instructions for wound care and follow-up.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A skin cancer better treated another way, such as radiotherapy for certain sites or in people unfit for surgery.
- A cancer that should first be assessed and planned by a skin cancer multidisciplinary team before any surgery.
- Surgery without a tissue diagnosis, where the lesion has not been confirmed as cancer.
- A patient too unwell for the planned anaesthetic or repair, where a less invasive option may be safer.
Delay surgery if…
- There is an active skin infection at the site.
- Blood thinners need adjusting and a safe plan has not been agreed.
- The diagnosis or margins plan has not yet been discussed by the appropriate team.
- You are acutely unwell or have an uncontrolled medical problem affecting anaesthesia or healing.
Alternatives to discuss
- Mohs micrographic surgery instead of standard excision for high-risk or facial sites.
- Radiotherapy, particularly for people unfit for surgery or where surgery would be disfiguring.
- Curettage and cautery, cryotherapy or topical creams for selected low-risk superficial cancers.
- Active monitoring in very frail patients where treatment may cause more harm than the cancer.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Removes the cancer with the aim of clear margins
- Provides a laboratory result confirming the type of cancer and whether it was fully removed
- Often gives good long-term control of non-melanoma skin cancers
- Mohs surgery can spare healthy facial tissue while checking margins thoroughly
- Allows the wound to be repaired to protect appearance and the function of eyelids, nose and lips
Risks & complications
- A scar, which is permanent though it usually fades over many months
- Bruising, swelling and redness, especially around the eyes
- Temporary numbness around the wound
- Tightness or a change in the contour of the area
- Incomplete removal needing further surgery to clear the margins
- Wound infection
- Bleeding or a collection of blood under the wound
- Part of a skin graft or flap not healing fully
- Lasting numbness if small sensory nerves are affected
- Distortion of nearby features such as an eyelid being pulled (ectropion), the nose or the lip
- Weakness of a facial muscle if a motor nerve branch is affected
- The cancer coming back despite surgery, sometimes needing more treatment
The biggest issues are whether the cancer is fully removed and how the repair affects appearance and function on the face. Margins reported as not clear may mean a second operation. Surgery near the eyes, nose, ears and lips carries a higher risk of distortion or nerve effects. Ask whether your case has been through a skin cancer multidisciplinary team, whether Mohs surgery is appropriate, what the repair will involve, and what happens if the margins are not clear.
Published figures to discuss
Most non-melanoma facial skin cancers are controlled well by surgery, but outcomes depend on the type of cancer, its size and site, whether it is new or recurrent, and your immune status. The key 'rates' are about complete removal and the chance of the cancer returning, rather than serious operative complications, which are uncommon. Cure rates quoted in guidelines are high but are not guarantees for an individual.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Five-year cure after Mohs surgery for high-risk basal cell carcinoma | Around 97% in UK national guidelines | High, but not a guarantee; depends on tumour and patient factors. | Non-melanoma skin cancer: UK National Multidisciplinary Guidelines — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Complete excision with a standard 4–5 mm margin for small BCC | About 95% complete in guideline data | A small proportion still have involved margins and need further surgery. | Non-melanoma skin cancer: UK National Multidisciplinary Guidelines — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Recommended margin and follow-up for higher-risk squamous cell carcinoma | Margins of 6 mm or more; review three- to six-monthly for two years | Higher-risk cancers carry a greater chance of local recurrence or spread, so closer follow-up is advised. | Non-melanoma skin cancer: UK National Multidisciplinary Guidelines — PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery depends mainly on how big the cancer was and how the wound was repaired. A small direct closure heals quickly, while a flap or graft takes longer and needs more careful wound care.
- A red, swollen and bruised area in the first week, easing over time
- Numbness around the scar that may slowly improve, but can be permanent
- Tightness or a raised, firm scar that softens over months
- Swelling around the eye if surgery was near it
- Waiting a few weeks for the laboratory report on the margins
Aftercare
- Follow the wound-care and dressing instructions exactly, and keep the area dry as directed.
- Take painkillers as advised and report increasing rather than easing pain.
- Protect the healing area and scar from the sun with high-factor sunscreen or a hat once healed.
- Avoid heavy lifting, bending or strenuous exercise in the early days to reduce bleeding and swelling.
- If you have a skin graft, care for both the graft and the place the skin was taken from.
- Attend all follow-up appointments, including to hear the margin result.
- Keep checking your skin and report any new or changing spots, as people who have had one skin cancer can develop more.
- Dressings or supplies as advised by the team
- High-factor sunscreen and a hat for after healing
- Painkillers suitable for you
- A note of stitch-removal and follow-up dates
- The result appointment for the margins booked
- The clinic's contact number for bleeding or infection
Scars and how they heal
Facial skin cancer surgery always leaves a scar, because tissue has to be removed. Surgeons place and repair wounds to follow natural skin lines and protect features such as the eyelids and lips. Scars are red and firm at first and usually soften and pale over many months, sometimes up to two years. Larger removals, flaps or grafts leave more noticeable marks, and a graft also leaves a scar where the skin was taken from. Sun protection helps scars settle.
⚠ Get urgent help if…
- Increasing redness, swelling, warmth or pus around the wound (signs of infection)
- Bleeding that does not stop with gentle pressure
- A rapidly swelling, painful, tense area under the wound
- Pain that gets worse rather than better after the first days
- A graft or flap turning dark, cold or breaking down
- A high temperature or feeling generally unwell
- Any sudden problem with vision if surgery was near the eye — seek urgent help
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the laboratory confirms the cancer has been removed with clear margins, and the wound heals to protect your appearance and the function of nearby features. For many non-melanoma skin cancers, surgery gives good long-term control.
No operation can promise a cancer will never return. Margins reported as involved (not clear) usually mean further surgery is advised. Some higher-risk cancers carry a chance of coming back locally or, less often, spreading, which is why the type, completeness of removal and your overall risk guide how closely you are followed up. A clear result is reassuring but is not the same as a guarantee for the future.
Once a cancer is fully removed, the treated area is usually stable, but the scar keeps maturing for months to a couple of years. People who have had one non-melanoma skin cancer have a higher chance of developing another, so ongoing sun protection and regular skin checks matter. How long you are followed up depends on the type of cancer and your individual risk, as advised by your team.
Combining with other procedures
Skin cancer surgery is often combined with reconstruction in the same operation, and sometimes with treatment of other sun-damaged or pre-cancerous areas. For higher-risk cancers, surgery may be combined with radiotherapy or other treatments, and decisions are made with a skin cancer multidisciplinary team. Some people are also seen by dermatology for ongoing skin surveillance.
Follow-up & long-term care
You will be seen to remove stitches and check healing, and to discuss the laboratory result on the margins. If the margins are clear and the risk is low, you may be discharged after one visit; for higher-risk squamous cell cancers, regular reviews (for example every three to six months for up to two years, then yearly depending on risk) are usual. Further surgery or treatment is arranged if the margins are not clear or the cancer recurs.
- Lifelong sun protection with high-factor sunscreen, clothing and shade
- Regular self-examination of the skin for new or changing spots
- Attending follow-up skin checks for the period your team advises
- Prompt review of any new lesion, especially in people who have had skin cancer before
Revision and secondary surgery reality
- If the margins come back involved, a further operation is often needed to clear the cancer.
- Some cancers recur locally even after clear margins and may need more surgery or other treatment.
- Reconstruction is sometimes staged or revised to improve appearance or function.
- People who have had one skin cancer often develop further lesions needing treatment over time.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear written wound-care instructions and a named contact for problems.
- A defined process and appointment for receiving the margin result.
- A plan for further surgery if the margins are not clear.
- An agreed follow-up schedule based on the type of cancer and your risk.
- Strong sun-protection advice and guidance on checking your skin for new lesions.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The surgeon's fee, which varies with the size, site and complexity of the cancer
- Whether standard excision or Mohs micrographic surgery is used
- The type of repair — direct closure, local flap or skin graft
- Anaesthetic or sedation if needed, and theatre or facility fees
- The laboratory (histopathology) fee for checking the margins
- Follow-up appointments and any further surgery if margins are not clear
- Skin cancer multidisciplinary team input for higher-risk cases
- The surgeon's fee and whether reconstruction is included
- The facility or theatre fee and any anaesthetic or sedation fee
- The separate laboratory fee for checking the margins
- What happens, and what it costs, if the margins are not clear and further surgery is needed
- The cost and timing of follow-up appointments
- Whether the cancer has been discussed by a skin cancer multidisciplinary team
- The cancellation policy
On the NHS? Surgery for facial skin cancer is core NHS cancer care, usually arranged urgently through a skin cancer team; private treatment is mainly chosen for speed or choice of surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Promising a 'cure' rather than explaining clear margins and a chance of recurrence.
- Not discussing the scar, flap or graft and how the face may look afterwards.
- Operating without confirming the diagnosis or without multidisciplinary team input for higher-risk cases.
- Not explaining what happens if the margins are not clear.
- Underplaying the higher risks of surgery near the eyes, nose, ears and lips.
Marketing red flags
- Claims that surgery guarantees a cure or that the cancer 'will never come back'.
- Promises of 'scarless' facial skin cancer removal.
- Treating skin cancers without a laboratory diagnosis or margin checking.
- Skipping multidisciplinary team discussion for facial or high-risk cancers.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Has my case been discussed by a skin cancer multidisciplinary team?
- Is standard excision or Mohs surgery better for my cancer and its site?
- How will you repair the wound, and what scar should I expect?
- What is my personal risk of the cancer coming back?
- What happens if the margins are not clear?
- How long and how often will I be followed up?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will surgery cure my skin cancer?
Will I be left with a noticeable scar?
What is Mohs surgery and do I need it?
Can I have this on the NHS?
What happens if the margins are not clear?
Will the surgery affect my eyelid, nose or lip?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Skin cancer (non-melanoma) Cancer Research UK — Skin cancer Non-melanoma skin cancer: UK National Multidisciplinary Guidelines — PMC NICE — Skin cancer guidance (NG14) British Association of Dermatologists — patient information
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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