Skin cancer procedures: diagnosis and treatment
Careful diagnosis comes first
Before deciding on treatment, your doctor needs to first understand what the lesion is. This may involve a clinical examination, advanced imaging, monitoring the lesion over time, or taking a tissue sample for pathology testing.
Once there is enough information to make a diagnosis, your doctor can recommend the most appropriate next step. This will depend on factors such as the type of lesion, its size, location and depth, any risk features and your individual medical history.
The goal is to manage the lesion appropriately while also considering the surrounding healthy tissue, normal function and cosmetic outcome.
Biopsy and pathology
If a lesion looks suspicious or needs further investigation, your doctor may recommend a biopsy.
A biopsy is a minor procedure where a sample of skin is removed and sent to a pathology laboratory for testing. This helps confirm whether the lesion is benign, pre-cancerous or a type of skin cancer.
Depending on the lesion and type of biopsy performed your doctor may remove a portion or all of the lesion.
Where possible, removing the whole lesion can give the pathologist the most complete information. However, a partial biopsy may be more appropriate if the lesion is large, located in a sensitive area, or if the final treatment may involve a non-surgical option.
Your doctor will explain which biopsy type is most suitable and why.
Types of biopsy
Punch biopsy
A punch biopsy removes a small, circular sample of skin using a tool that works like a small cookie cutter. It allows the doctor to take a deeper sample of the lesion.
This may be recommended when the doctor needs more information about what is happening below the surface.
Shave biopsy
A shave biopsy removes a thin sample from the surface of the skin using a flexible blade.
This may be used for raised or surface level lesions where a deeper sample is not required.
Excision biopsy
An excision biopsy removes the whole lesion, usually with a narrow margin of surrounding skin.
This may be recommended when the doctor wants the entire spot tested or removed. The area is usually closed with stitches, depending on the size and location of the lesion.
Incisional biopsy
An incisional biopsy removes only part of a larger lesion.
This may be recommended when removing the whole lesion at the first appointment is not practical, as the lesion is large or located in a cosmetically or functionally sensitive area.
What happens after a biopsy?
After your biopsy, the sample is sent to a pathology laboratory for testing. This is called histopathology.
Results are usually available within around one week, although they can sometimes take longer if further testing, special stains or a second opinion is needed.
Your doctor or a member of the Solvera team will contact you if you need to return for further management. As a safeguard, we also recommend contacting the clinic if you have not received your result within two weeks.
Why further treatment may still be needed
Sometimes a biopsy removes the visible lesion and the skin looks normal to the naked eye, but further treatment is still recommended.
This is because some skin cancers require a wider safety margin of 'normal' looking skin around the original lesion. This helps reduce the chance of tumour cells being left behind.
For example, Australian guidelines recommend a wider follow-up excision for an early or thin melanoma, even when the initial biopsy appears to have removed the cancer with a narrow but clear margin. This removes a further margin, or safety buffer, of surrounding skin to treat any melanoma cells that may remain beyond the original biopsy site and reduce the risk of recurrence. The final pathology report will usually show only scar tissue and no remaining melanoma in the surrounding skin. This is a reassuring result.
Treatment options
If a skin cancer is diagnosed, your doctor will explain the most appropriate treatment options. This is a personalised discussion that takes into account a range of factors, including the type of skin cancer, its size, depth, location, risk features, other relevant medical conditions and your individual circumstances. Your own priorities are also part of this discussion, for example, one person may prioritise a quicker return to work, while another may place greater importance on recovery time, function or appearance. Your doctor will talk you through these considerations so you can make an informed decision together.
Most skin cancers, particularly when found early, can often be managed with a relatively straightforward treatment plan. Early diagnosis and treatment can improve the likelihood of a favourable outcome. Where more complex treatment is required, your doctor will seek input from, or refer you to, other appropriate specialists as part of your ongoing care.
Treatment may include surgical or non-surgical options.
Non-surgical treatment
Not all skin cancers require surgical removal. Some early, superficial or low-risk lesions may be suitable for non-surgical treatment.
Your doctor will only recommend these options when they are appropriate for the type of lesion, its location and your overall risk.
Cryotherapy
Cryotherapy uses liquid nitrogen to freeze selected abnormal or pre-cancerous spots.
It is commonly used for actinic keratoses, also known as solar keratoses, and may occasionally be used for very low-risk superficial lesions.
The treated area may feel sore and can take one to two weeks to heal.
Topical treatments
Some superficial skin cancers or pre-cancerous areas may be treated with prescription creams.
These creams are applied at home over a set period. Depending on the medication, they may work by stimulating the immune system or by stopping abnormal cells from multiplying.
Topical treatments are not suitable for every skin cancer. Your doctor will explain how to use the treatment, what reaction to expect, and when to return for review.
Photodynamic therapy
Photodynamic therapy, often called PDT, may be used for selected sun-damaged areas and some superficial skin cancers.
A special cream is applied to the treatment area and left to absorb. A specific light is then used to activate the cream, which helps destroy abnormal cells.
PDT is only suitable for selected low-risk lesions and is not used for all skin cancers.
Radiotherapy & other specialist treatments
In some situations, radiotherapy may be recommended. This may include more aggressive skin cancers, cancers involving nerves, or cases where further surgery is not suitable because of the location or complexity of the lesion.
Radiotherapy and other hospital based cancer treatments are provided through specialised cancer care services. If this is needed, your doctor will discuss the reason for referral and help guide the next step.
Surgical treatment
Surgery is one of the most common treatments for skin cancer, particularly when it is found early. The cancer is removed along with an appropriate margin of surrounding tissue, which is then examined by pathology. In many cases, no further treatment is required, although this will depend on the type of skin cancer, the pathology results and other individual risk factors.
Excision
An excision is a procedure used to remove a suspicious or confirmed skin cancer. The area is numbed with local anaesthetic, the lesion is removed, and the skin is closed with stitches where needed.
The removed tissue is usually sent to a pathology laboratory to confirm the diagnosis and check whether further treatment is required.
Curettage & cautery
Curettage and cautery may be used for carefully selected, low-risk skin cancers.
During this procedure, the lesion is gently scraped away and the base is treated with heat to help destroy remaining abnormal cells and reduce bleeding.
This option may be suitable for some small, low-risk lesions, such as selected superficial basal cell carcinomas. It is not suitable for all skin cancers or all body sites.
Your doctor will explain whether this approach is appropriate for your diagnosis.
Flaps and skin grafts
Some skin cancers require a larger area of skin to be removed. If the wound cannot be closed in a straight line, your doctor may recommend a skin flap or skin graft.
These techniques use nearby skin or skin from another area of the body to repair the wound and support healing, function and appearance.
After treatment: follow up and prevention
Treatment does not end when the lesion is removed or managed.
After treatment, your doctor will recommend a follow up plan based on your diagnosis, the type of treatment used, your previous history of skin cancer, your level of sun damage and your general health.
Follow up appointments may help:
- check that the treated area is healing as expected
- review pathology results where relevant
- monitor for recurrence
- identify new or changing lesions
- update your skin check schedule
- support prevention and self check habits
Reducing future risk
A skin cancer diagnosis can be a useful opportunity to review your skin health more broadly.
While not all skin cancers can be prevented, reducing UV exposure and checking your skin regularly can help lower the chance of future problems being missed.
Your doctor may recommend:
- regular full body skin checks
- monitoring particular lesions with photography
- total body photography if you have many moles or higher risk features
- treatment of surrounding sun damage where appropriate
- a tailored review schedule based on your risk
- self checks at home between appointments
- consistent sun protection when the UV index is 3 or above
It is important to become familiar with your own skin. If you notice a new spot, a changing mole, a sore that does not heal, or a lesion that bleeds, crusts, itches or looks different from the others, book a review rather than waiting for your next routine appointment.
For more advice on prevention and year round skin awareness, read our blog: Skin checks are not just for summer.
Patient information
Solvera has patient handouts available for many treatment options, including excision, curettage and cautery, cryotherapy, topical treatments and photodynamic therapy.
Please ask your doctor or our team if you would like more detailed information about a procedure or treatment that has been recommended for you.
Book an appointment
If you have a suspicious spot, have been advised to have a biopsy, or need treatment for a diagnosed skin cancer, you can book an appointment with Solvera or call our clinic to discuss the most appropriate appointment type.
Book a skin cancer check
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