Surgical dermatology is a crucial branch of dermatological care that focuses on diagnosing and treating skin conditions through surgical means. While many skin issues can be managed with topical or systemic treatments, certain conditions require a more definitive approach. Skin surgery is typically reserved for situations where lesions are malignant, persist despite conservative treatments, or pose significant functional or aesthetic problems.
Dermatological surgeons are trained to not only remove these problematic growths but also to do so with a strong emphasis on preserving appearance and functionality. Understanding when surgery is the right choice can empower patients to make informed decisions about their skin health. For many, it marks a turning point in managing chronic or worrying skin concerns. It’s an area where precision, care, and long-term thinking are essential.
Skin Cancer: The Most Common Reason for Skin Surgery
One of the most common reasons for dermatological surgery is the removal of skin cancer. Basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma are the main types of skin cancers treated surgically. Early diagnosis plays a vital role in ensuring successful outcomes. Surgical excision is often recommended to remove the entire cancerous lesion along with a margin of healthy tissue to ensure complete clearance. In certain cases, a specialised technique called Mohs micrographic surgery is used, which allows real-time microscopic examination of tissue margins.
This method is especially useful for cancers on cosmetically or functionally sensitive areas like the face, ears, or hands. The goal is not only to eradicate the cancer but also to preserve as much healthy tissue as possible. Patients are also monitored closely post-procedure to catch any recurrence early. Education on sun protection and regular skin checks becomes a lifelong priority.
Benign Growths and Cysts: When Surgery Is the Sensible Solution
While many benign skin growths—such as seborrhoeic keratoses, skin tags, or lipomas—do not pose a medical threat, they can still cause discomfort, cosmetic concern, or functional issues. Cysts, particularly epidermoid and pilar cysts, may become inflamed or infected, leading to pain and recurring abscesses. Surgical removal is often the best option when these lesions are large, symptomatic, or prone to recurrence.
Dermatological surgeons typically perform minor procedures under local anaesthesia, using techniques that minimise scarring and reduce the risk of recurrence. Even though these growths are non-cancerous, their removal can significantly improve a patient’s quality of life, self-esteem, and comfort.
Post-operative care is straightforward, and patients can often return to normal activities within days. For those with recurring cysts or lipomas, surgery can bring long-term relief.
Persistent Lesions and Diagnostic Uncertainty: The Role of Biopsy
Not all skin lesions are immediately diagnosable based on visual inspection. In cases where there is diagnostic uncertainty—such as changing moles, non-healing patches, or lesions that do not respond to standard treatment—a biopsy may be necessary.
Dermatologists use several types of biopsies depending on the location, size, and suspected diagnosis. These include punch biopsies, shave biopsies, and excisional biopsies. A punch biopsy takes a cylindrical sample that includes deeper layers of the skin, while a shave biopsy removes the top layers.
An excisional biopsy involves removing the entire lesion, often used when melanoma is suspected. Surgical biopsies not only aid in diagnosis but also sometimes double as curative treatment if the entire problematic tissue is removed. Follow-up pathology reports guide further treatment if required. Timely biopsy can often catch serious issues early, improving prognosis.
Cosmetic Considerations in Surgical Dermatology
Surgical dermatology is not just about removing skin abnormalities—it also requires a keen understanding of cosmetic outcomes. Dermatological surgeons are trained to balance medical necessity with aesthetic concerns, particularly when operating on the face, neck, or other visible areas.
Techniques such as layered closure, subcuticular sutures, and precise incision placement along natural skin lines help reduce visible scarring. In addition, patients are often provided with detailed post-operative care instructions and may be offered scar-reduction treatments, such as silicone gel, laser therapy, or microneedling, to enhance healing.
This dual focus on health and appearance is what distinguishes surgical dermatology from general surgery and is especially appreciated by patients undergoing procedures in highly visible areas. Surgeons also collaborate with cosmetic dermatologists for complex reconstructions. Advances in technology continue to improve outcomes in both function and appearance.
Treatment-Resistant Skin Conditions: A Surgical Answer
Some skin conditions resist conventional treatments and may require surgical intervention. Examples include severe cases of hidradenitis suppurativa, where inflamed nodules and sinus tracts form in areas such as the underarms and groin. In such cases, surgical excision of the affected tissue may be the only way to control flare-ups and improve function. Similarly, chronic warts that fail to respond to topical or cryotherapy treatments might be surgically removed.
In rare cases, disfiguring scars, keloids, or congenital naevi may also warrant excision, particularly if they are causing psychological distress or physical discomfort. Surgery becomes not just a treatment, but a pathway to relief and improved quality of life when all else fails. Careful planning and post-surgical management help minimise recurrence. Patients often report significant lifestyle improvements following successful surgical interventions.
Mohs Micrographic Surgery: A Precision Technique for High-Risk Skin Cancers
Mohs surgery is considered the gold standard for treating certain high-risk or recurring skin cancers, particularly on the face and other sensitive areas. The procedure involves removing cancerous tissue layer by layer, with each layer examined under a microscope in real-time until no abnormal cells remain.
This meticulous process allows for the highest cure rates—up to 99% for basal cell carcinoma—while sparing as much healthy tissue as possible. It is especially beneficial in areas where tissue preservation is critical, such as near the eyes, nose, or lips.
Mohs surgery is typically performed in a single day under local anaesthesia, offering minimal downtime and highly precise results. Its success depends on both surgical skill and immediate pathology expertise. Patients appreciate the comprehensive care delivered in one visit.
Reconstructive Surgery Following Excision
When a lesion is large or located in a structurally significant area, reconstructive surgery may be required following its removal. Dermatological surgeons are trained in various closure techniques to minimise scarring and restore natural appearance and function. In simple cases, direct closure with stitches may suffice, but more complex wounds may require flaps (where adjacent skin is repositioned) or grafts (where skin is taken from another area).
These advanced techniques are especially important in areas like the eyelids, nose, or hands, where both form and function must be preserved. Patients are usually given detailed aftercare instructions to promote optimal healing, and follow-up appointments ensure any complications are promptly addressed. Coordination with plastic surgery may be needed in complex reconstructions. Ensuring both aesthetics and utility is the primary goal.
Surgical Treatment for Nail and Scalp Conditions
Surgical dermatology also addresses issues beyond the surface of the skin, including the nail matrix and scalp. Conditions like ingrown toenails, nail tumours, or subungual melanomas may require partial or complete nail removal for treatment and diagnosis. On the scalp, cysts, lipomas, or even early skin cancers often require excision.
These areas present unique challenges due to limited elasticity and visibility, but dermatological surgeons are skilled in techniques that respect the anatomy and hair-bearing regions of the body. Surgery in these locations is carefully planned to avoid permanent hair loss or functional impairment, making it a highly specialised area within the field. Follow-up often includes measures to stimulate hair regrowth. Special attention is also paid to infection prevention in these dense tissue areas.
Paediatric Surgical Dermatology: Special Considerations for Younger Patients
When it comes to surgical dermatology in children, extra care is taken to ensure procedures are as safe, gentle, and minimally invasive as possible. Children may present with congenital lesions such as haemangiomas, dermoid cysts, or congenital naevi that require surgical intervention either for medical reasons or to prevent future complications. Paediatric patients often need tailored anaesthetic plans and smaller, more delicate instruments.
In some cases, general anaesthesia may be used to ensure the child remains still and comfortable throughout the procedure. Parents are also guided through the recovery process, with clear instructions on wound care, follow-up, and scar management to ensure optimal long-term outcomes. Surgeons aim to make the experience as stress-free as possible for both child and parent. Early treatment can also reduce long-term cosmetic or psychological issues.
Post-Surgical Scar Management and Recovery
A key concern for many patients undergoing skin surgery is the appearance of scars. While some scarring is inevitable, dermatological surgeons use refined techniques to minimise their visibility. Additionally, proactive scar management begins immediately after surgery. Silicone gel or sheets, pressure dressings, and sun protection are commonly recommended to promote flat, pale scars.
In some cases, further treatment such as fractional laser resurfacing, microneedling, or steroid injections may be advised to improve the final cosmetic result. Regular follow-up appointments also allow dermatologists to monitor healing and address any complications early. Patient adherence to aftercare instructions is crucial for optimal results. Over time, most scars fade and become barely noticeable.
Skin Surgery for Precancerous Lesions: Actinic Keratoses and Beyond
Precancerous skin lesions, such as actinic keratoses, are another key area where surgical dermatology plays a preventive role. These lesions often appear as rough, scaly patches on sun-exposed areas like the face, scalp, and hands and have the potential to progress into squamous cell carcinoma if left untreated. While many can be managed with topical treatments or cryotherapy, thicker or suspicious lesions may require surgical removal for both diagnostic confirmation and complete clearance.
A punch or shave excision can be used to remove the lesion and send it for histological analysis. Catching and treating these lesions early is essential, especially in individuals with a history of excessive sun exposure or immunosuppression. This proactive approach helps reduce long-term cancer risk and often results in better cosmetic outcomes.
Dermatosurgical Management of Pigmented Lesions
Pigmented lesions such as dysplastic naevi, blue naevi, or suspicious moles often warrant close monitoring—and, in some cases, excision. A change in size, shape, colour, or border may indicate atypical activity that could signify melanoma in its early stages. Dermatological surgeons use their clinical judgement alongside tools like dermoscopy to decide whether removal is necessary.
When excision is chosen, it’s typically performed with a safety margin to ensure complete clearance and submitted for laboratory examination. The results guide whether further intervention is needed. Surgical removal not only offers peace of mind but can be lifesaving, as early-stage melanoma is highly treatable when caught in time.
Patient Preparation and Psychological Considerations
Preparing a patient for skin surgery involves more than just outlining the procedural steps. Psychological readiness, understanding the reasons for surgery, and managing expectations are all key components of pre-operative care. Dermatologists must ensure patients are well-informed about possible risks, outcomes, and the appearance of post-surgical sites.
For some, especially when operating in visible areas or treating long-standing conditions, anxiety about pain or scarring can be significant. A clear explanation of the healing process, scar management techniques, and potential touch-up procedures can go a long way in reducing apprehension. A well-prepared patient is more likely to experience a smoother recovery and be satisfied with the outcome.
Innovations in Dermatological Surgery: Tools and Techniques
The field of dermatological surgery is constantly evolving, with innovations improving safety, efficiency, and patient outcomes. Advanced electrosurgical tools, radiofrequency devices, and laser-assisted procedures are now commonly used in minor surgeries to achieve greater precision and control bleeding.
In addition, absorbable sutures and tissue adhesives are making wound closures easier and more comfortable, particularly for patients who might otherwise need to return for stitch removal. Digital imaging tools now aid in lesion mapping and documentation, enhancing both diagnostic accuracy and long-term monitoring. These advancements reflect the growing sophistication of skin surgery, blending medical precision with patient-centred care.
Multidisciplinary Collaboration and Complex Cases
In complex or high-risk cases, dermatological surgeons often work alongside other specialists to provide comprehensive care. For example, if a skin cancer has spread beyond the dermis or involves underlying structures, collaboration with oncologists, plastic surgeons, or maxillofacial teams may be required.
This multidisciplinary approach ensures all aspects of the condition are addressed, from complete tumour removal to functional reconstruction and post-treatment monitoring. Likewise, patients with genetic syndromes or autoimmune skin diseases may benefit from joint management involving rheumatologists or geneticists. The integration of surgical dermatology into broader care pathways underscores its critical role in holistic skin health management.
Skin Surgery for Viral and Infectious Lesions
Although many viral skin lesions such as warts or molluscum contagiosum respond to non-surgical treatments, some stubborn or recurrent cases require surgical removal. Immunocompromised individuals, in particular, may develop extensive or treatment-resistant lesions that do not resolve with cryotherapy, acids, or topical immunomodulators. In such instances, curettage, excision, or electrosurgical techniques can be employed to remove the lesion and reduce viral load.
This approach is also considered when the lesion causes pain, bleeds easily, or interferes with daily activity. Surgical intervention not only addresses the physical aspect of the condition but also reduces transmission risks and psychological distress, especially when lesions are prominent or persistent.
Managing Skin Trauma and Complex Lacerations
Dermatological surgeons are also involved in the repair of complex skin trauma, particularly when cosmetic or functional restoration is needed. This includes facial lacerations, avulsions, or trauma involving the nail bed or ears. These injuries often require meticulous repair to minimise scarring and preserve normal appearance and function.
Advanced suturing techniques, precise alignment of skin edges, and post-operative follow-up are critical for optimal healing. Additionally, patients may be monitored for signs of infection, dehiscence, or hypertrophic scarring, which are more likely with deeper or contaminated wounds. Timely intervention and skilled surgical management significantly improve both short-term outcomes and long-term aesthetics.
The Importance of Follow-Up in Surgical Dermatology
Post-operative follow-up is an essential phase of surgical dermatology that ensures proper wound healing, early detection of complications, and assessment of treatment success. For procedures involving skin cancer or atypical lesions, follow-up appointments are critical for reviewing pathology results and planning any additional treatment if required.
They also offer an opportunity to educate patients on sun protection, skin surveillance, and signs of recurrence. Regular reviews help reinforce the patient–clinician relationship and foster a sense of ongoing care and reassurance. Additionally, any concerns about scar appearance, discomfort, or delayed healing can be addressed early, often preventing more complex issues later on.
Patient-Centred Care and Informed Consent
At the heart of surgical dermatology is the principle of patient-centred care. Every surgical decision—from whether to proceed with excision to choosing the closure technique—should be tailored to the patient’s medical history, lifestyle, and personal concerns. Informed consent is more than a signature on a form; it’s a process of shared understanding. Patients should leave the consultation knowing what the surgery involves, what outcomes to expect, and how to care for the area afterwards. This open dialogue improves compliance, trust, and overall satisfaction with the results. It also ensures patients feel empowered and respected throughout their surgical journey.
Final Words: A Critical Yet Considerate Approach to Skin Surgery
Surgical dermatology is both a science and an art—grounded in clinical precision, but deeply considerate of each patient’s experience. From cancer removal and resistant cysts to scar repair and trauma care, surgical intervention can dramatically improve health, appearance, and quality of life. With advancements in techniques and technology, today’s dermatological procedures offer excellent safety and increasingly refined cosmetic results.
The decision to proceed with surgery should always be collaborative, guided by evidence, clinical insight, and patient values. If you’re facing a skin condition that may warrant surgery, speak to a qualified dermatological surgeon. If you wish to consult with a leading private consultant surgical dermatologist in London, you can get in touch with us here at The London Dermatology Centre. With the right approach, skin surgery can be a life-changing step towards better health and greater confidence.
References:
- National Institute for Health and Care Excellence (NICE), 2020. Skin cancer: recognition and referral [NG12]. Available at: https://www.nice.org.uk/guidance/ng12 [Accessed 27 May 2025].
- British Association of Dermatologists (BAD), 2023. Surgical treatments in dermatology.
- Bath-Hextall, F., Ozolins, M., Armstrong, S.J., Colver, G.B., Perkins, W. and Miller, P., 2014. Surgical excision versus imiquimod for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial. Lancet Oncology, 15(1), pp.96–105.
- Rinker, M.H., Fenske, N.A. and Scalf, L.A., 2012. Mohs surgery: the treatment of choice for recurrent basal cell carcinoma. Dermatologic Surgery, 38(3), pp.385–391.
- Cancer Research UK, 2024. Skin cancer treatment: surgery. Available at: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/surgery [Accessed 27 May 2025].