Skin Cancer & Soft Tissue Surgery

Skin Cancer Overview

Skin cancer is the most common cancer in the United States. The three most common types are basal cell carcinoma, squamous cell carcinoma, and melanoma. While basal cell and squamous cell carcinomas are highly treatable when caught early, melanoma is more aggressive and requires prompt surgical treatment.

When a General Surgeon Is Needed

Dermatologists manage many skin cancers with office-based procedures such as Mohs surgery or shave excision. However, a general surgeon is typically involved when:

• The skin cancer is melanoma requiring wide local excision with specific margins
• Sentinel lymph node biopsy is needed for melanoma staging
• The tumor is large, deep, or in a location requiring surgical expertise beyond an office setting
• Soft tissue masses (lipomas, cysts) require excisional biopsy or removal

Surgical Procedures

Wide Local Excision

For melanoma and certain other skin cancers, wide local excision removes the tumor along with a margin of normal surrounding skin. The margin width is determined by the thickness (Breslow depth) of the melanoma, following established guidelines from the National Comprehensive Cancer Network (NCCN). The goal is to ensure complete removal and reduce the risk of local recurrence.

Sentinel Lymph Node Biopsy for Melanoma

For melanomas that are thicker than 0.8 mm or have other high-risk features, sentinel lymph node biopsy is recommended to determine whether cancer cells have spread to the regional lymph nodes. This information is critical for accurate staging and guiding further treatment decisions. The procedure involves injecting a tracer to identify the first lymph node(s) in the drainage pathway, which are then removed and examined by a pathologist.

Soft Tissue Mass Excision

Lipomas (benign fatty tumors), cysts, and other soft tissue masses may require surgical removal when they are large, growing, painful, or when the diagnosis is uncertain. Excisional biopsy provides tissue for pathologic analysis and is both diagnostic and therapeutic.

Recovery

• Office or outpatient setting: Most skin cancer excisions are performed on an outpatient basis
• Wound care: Specific instructions are provided based on the size and location of the excision
• Pathology results: Typically available within one to two weeks; Dr. Abbassi reviews the results with you and discusses any next steps
• Return to activity: Most patients resume normal activities within days, depending on the site and extent of surgery

Coordinated Care

Skin cancer treatment may involve collaboration with dermatologists, medical oncologists, and radiation oncologists depending on the type and stage of the cancer. Dr. Abbassi works closely with referring physicians throughout Rockwall, McKinney, and across North Texas to ensure seamless, coordinated care.

Frequently Asked Questions

What is the difference between Mohs surgery and wide local excision?

Mohs surgery is performed by a dermatologist and involves removing thin layers of skin and examining them under a microscope during the procedure. It is commonly used for basal cell and squamous cell carcinomas, especially on the face. Wide local excision, typically performed by a general surgeon, removes the tumor with predetermined margins and is the standard approach for melanoma.

How do I know if a mole needs to be removed?

See a dermatologist if a mole changes in size, shape, or color, has irregular borders, is asymmetric, or is larger than 6 mm (the size of a pencil eraser). These are the “ABCDE” criteria for concerning moles. If a biopsy shows melanoma or atypical features, your dermatologist may refer you to a surgeon for definitive excision.