In summary
- Around two in three Australians will be diagnosed with some form of skin cancer in their lifetime, and Australia has among the highest melanoma rates in the world, which makes regular skin checks and early detection essential.
- Mohs micrographic surgery removes certain skin cancers in stages, with each layer examined under a microscope, so the cancer can be fully cleared while preserving as much healthy tissue as possible.
- Plastic surgeons play a key role after skin cancer excision, reconstructing the wound with techniques ranging from direct closure to skin grafts and local flaps, with both function and appearance in mind.
Skin cancer is sometimes called Australia’s national cancer, and the description is well earned. Around two in three Australians will be diagnosed with some form of skin cancer during their lifetime, and Australia and New Zealand record the highest melanoma incidence in the world. Understanding the disease, the treatment options and the role of reconstruction can help you act early and make informed decisions if you ever face a diagnosis.
Why is skin cancer so common in Australia?
The combination of high ultraviolet (UV) radiation levels and a population with predominantly fair skin creates conditions for skin cancer that few other countries experience. Cancer Australia estimates that more than 17,000 new cases of melanoma will be diagnosed in 2025, making it the third most commonly diagnosed cancer nationally. Non-melanoma skin cancers, principally basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are even more common, accounting for well over a million Medicare-funded treatments each year.
Melanoma receives particular attention because of its capacity to spread to other parts of the body if left untreated. BCC and SCC spread far less often, but they can cause significant local tissue damage, particularly on the face.
Why does early detection matter so much?
Outcomes for skin cancer are strongly linked to how early it is found. Melanoma detected while it is still thin and confined to the skin is associated with high survival rates, whereas deeper or more advanced disease is considerably harder to treat.
Early detection also matters for the surgery itself. A small lesion caught early can often be removed with a modest excision and a simple closure. A larger or neglected lesion may require more extensive surgery and more complex reconstruction. Regular self-checks, professional skin examinations and prompt attention to any new, changing or unusual spot all improve the chance of catching a cancer while treatment is straightforward. If you notice a change in your skin, see your GP or a dermatologist promptly.
What is Mohs surgery and how does it preserve healthy tissue?
Mohs micrographic surgery is a staged technique used for certain skin cancers, particularly high-risk BCC and SCC in areas where conserving tissue matters, such as the nose, eyelids, lips, ears and scalp. It is also considered for cancers that have recurred after previous treatment.
The procedure is performed under local anaesthetic. The surgeon removes a thin layer of visible tumour, which is then mapped, colour-coded and examined under a microscope by a specialist pathologist. If cancer cells remain at any margin, another layer is removed from that precise location only. The process repeats until the margins are clear.
This layer-by-layer approach gives the surgical team microscopic confirmation that the cancer has been fully removed, while sparing healthy skin that a conventional wide excision might otherwise take. On the face, where every millimetre of tissue affects both appearance and function, that precision is especially valuable.
What role do plastic surgeons play after skin cancer excision?
Once the cancer is cleared, the wound needs to be repaired, and this is where reconstructive plastic surgery comes in. The choice of technique depends on the size, depth and location of the defect, as well as your general health and skin quality. Options include:
- Direct closure, where the edges of the wound are brought together with sutures.
- Skin grafting, where skin is taken from another part of the body to cover the defect.
- Local flap reconstruction, where nearby skin and tissue are repositioned to fill the wound while matching the surrounding skin in colour and texture.
- Healing by secondary intention, where suitable wounds are allowed to heal naturally.
Plastic surgeons train extensively in these techniques, and their involvement aims to restore both function (such as eyelid closure or nasal breathing) and appearance. At Southern Aesthetic, reconstruction after Mohs surgery is performed in collaboration with a specialist dermatologist, reflecting the multidisciplinary approach that complex facial skin cancers often require.
What are the risks and what should you do next?
As with any surgery, skin cancer excision and reconstruction carry risks, including bleeding, infection, delayed wound healing, scarring and changes in sensation. There is also a possibility that further treatment or revision surgery may be needed. Your surgeon will discuss the risks relevant to your situation, along with the alternatives, so you can make an informed decision.
If you have been diagnosed with a skin cancer, or have a spot that concerns you, speak with your GP about referral to a dermatologist or a specialist plastic surgeon registered with the Medical Board of Australia. A consultation is the most reliable way to understand which treatment pathway suits your circumstances.
FAQs
How long does Mohs surgery take? Each stage of removal and microscopic examination takes around 30 minutes, and most patients require two to three stages. You should allow several hours for the appointment, although much of that time is spent waiting while tissue is examined.
Is Mohs surgery used for melanoma? Mohs surgery is primarily used for non-melanoma skin cancers such as BCC and SCC. Melanoma is usually treated with wide local excision, although Mohs may be considered for selected rare skin cancers where tissue preservation is important. Your treating team will recommend the appropriate approach.
Will I have a scar after reconstruction? Yes. All surgery leaves a scar. Reconstructive techniques aim to position scars within natural skin lines and creases so they become less noticeable as they mature, although scar appearance varies between individuals.
How often should I have my skin checked? This depends on your personal risk factors, including skin type, sun exposure history, family history and any previous skin cancers. Your GP or dermatologist can recommend an appropriate schedule, and monthly self-checks are a sensible habit for most Australians.
Does Medicare cover skin cancer surgery? Skin cancer excision and medically necessary reconstruction generally attract Medicare item numbers, although out-of-pocket costs vary depending on the procedure, the facility and your private health cover. Costs are discussed during consultation before any decision is made.
Glossary of terms
Basal cell carcinoma (BCC): The most common form of skin cancer. It is usually slow growing and rarely spreads, but can damage surrounding tissue if untreated.
Squamous cell carcinoma (SCC): A skin cancer that can grow more quickly than BCC and carries a higher risk of spreading to lymph nodes if not managed early.
Melanoma: A cancer of the pigment-producing cells of the skin. It is less common than BCC and SCC but more likely to spread to other parts of the body.
Mohs micrographic surgery: A staged surgical technique in which skin cancer is removed in thin layers, with each layer examined under a microscope until the margins are clear.
Margin: The edge of tissue removed around a cancer. Clear margins indicate that no cancer cells are seen at the edges of the excised tissue.
Local flap: A reconstructive technique in which nearby skin and tissue are moved to cover a surgical wound while remaining attached to their blood supply.
Secondary intention: Allowing a wound to heal naturally without sutures, grafts or flaps, in cases where this is expected to produce a good result.
