Skin cancer surgery is the most effective treatment for the great majority of skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. At her Harley Street practice in London, Ms Anna De Leo offers prompt assessment of suspicious lesions and surgical excision with appropriate margins, histological confirmation and, where needed, reconstruction using local flaps or skin grafts designed to protect function and appearance.
Skin cancer is the most common cancer in the UK, and its incidence continues to rise. The encouraging news is that, when detected early, most skin cancers can be treated successfully with a single, well-planned operation. If you have a mole or patch of skin that is new, changing, bleeding or not healing, please do not wait — arrange to have it assessed, either with your GP or through a specialist consultation.
01What Is Skin Cancer Surgery?
Skin cancer surgery means removing a cancerous or suspected cancerous lesion together with a rim of normal-looking skin around it, known as the surgical margin. The removed tissue is sent to a pathologist, who examines it under the microscope to confirm the diagnosis and check that the cancer has been completely removed. The wound is then closed in the way that best preserves function and appearance — directly, with a local flap or with a skin graft.
The main types of skin cancer
- Basal cell carcinoma (BCC): the most common skin cancer. It often appears as a pearly or shiny bump, a non-healing sore or a scaly patch, typically on sun-exposed skin of the face. BCCs grow slowly and very rarely spread, but can cause significant local damage if neglected.
- Squamous cell carcinoma (SCC): often a firm, scaly or crusted lump that may be tender and grow over weeks to months. SCCs carry a small but real risk of spreading, so timely treatment matters.
- Melanoma: a cancer of the pigment cells. It may arise in an existing mole or as a new dark spot, and although less common than BCC or SCC, it is more likely to spread if not removed early.
Precancerous changes such as actinic keratoses and Bowen's disease (SCC in situ) are also assessed; many respond to creams, cryotherapy or other non-surgical treatments, while others are best excised.
02Warning Signs: When to Seek Prompt Assessment
Early detection makes skin cancer simpler to treat and improves outcomes. The ABCDE guide is a helpful way to check moles:
- A — Asymmetry: the two halves look different.
- B — Border: ragged, notched or blurred edges.
- C — Colour: several shades of brown, black, pink, red or blue.
- D — Diameter: larger than about 6mm, although melanomas can be smaller.
- E — Evolving: any change in size, shape, colour, height or symptoms.
Also seek advice for any spot that bleeds, itches, crusts, or fails to heal within a few weeks, and for any new lump that is growing. People at higher risk include those with fair skin, many moles, a history of sunburn or sunbed use, a previous skin cancer, a family history of melanoma, or a weakened immune system, for example after an organ transplant.
In the NHS, GPs can refer suspected skin cancers on an urgent suspected-cancer pathway. A private consultation on Harley Street can offer a rapid alternative or a second opinion, and the two routes can work together.
03Your Consultation on Harley Street
At 64 Harley Street in Marylebone, Ms Anna De Leo will ask about the history of the lesion, your sun exposure, previous skin cancers and general health, including any blood-thinning medication. She will examine the lesion closely, often with dermoscopy, check the surrounding skin and, where relevant, the nearby lymph nodes. You are welcome to ask her to look at any other moles that concern you, including those in areas you may feel shy about showing; many patients appreciate that this examination is carried out by a female surgeon.
If skin cancer is suspected, the next step is usually a biopsy or a complete excision biopsy under local anaesthetic, so that a definitive diagnosis can be made. For suspected melanoma, UK guidance recommends complete excision with a narrow margin first, rather than a partial sample, so that the pathologist can measure its thickness accurately.
Factors that influence the cost of a personalised plan include the number, size and site of lesions, whether a flap or graft is required, the anaesthetic used, histology fees and follow-up. Because skin cancer surgery is medical rather than cosmetic, treatment is planned without unnecessary delay.
04Skin Cancer Surgery Techniques and Margins
Excision with appropriate margins
The margin is chosen according to the type of cancer, its size, its location and how clearly defined it is. As a general guide, a small, well-defined BCC is commonly excised with a margin of around 4mm, while SCCs usually need a slightly wider margin. For melanoma, the initial excision biopsy is followed — once the thickness (Breslow depth) is known — by a wide local excision with a margin typically between 0.5cm and 2cm, according to national guidelines.
Histology and clear margins
Every specimen is examined by a pathologist. The report confirms the diagnosis and states whether the margins are clear. If cancer cells reach the edge, a further excision or other treatment is usually recommended, and Ms De Leo will discuss this with you in person.
Reconstruction with flaps and grafts
On the trunk and limbs many wounds can be closed directly in a neat line. On the face — the nose, eyelids, lips, ears and cheeks — closing the defect while preserving function and natural contour is a specialised skill. Ms De Leo uses:
- Local flaps — moving adjacent skin of matching colour and texture into the defect, with incisions hidden in natural creases and along Langer's lines of minimal tension.
- Skin grafts — full-thickness grafts, often from behind the ear or above the collarbone, for areas where a flap is unsuitable.
- Delayed reconstruction — in selected cases, the wound is dressed for a short time until clear margins are confirmed before definitive reconstruction.
For some facial BCCs, Mohs micrographic surgery may be recommended and Ms De Leo will refer appropriately when that offers you the best outcome.
In skin cancer surgery, complete removal comes first — careful reconstruction then ensures that clearing the cancer does not cost you function or confidence.
ADLSynergy · Harley Street
05Multidisciplinary Care and the NHS Pathway
Skin cancer care in the UK is organised around specialist skin cancer multidisciplinary teams (MDTs), which bring together dermatologists, plastic surgeons, pathologists, oncologists and specialist nurses. Melanomas, higher-risk SCCs and complex or recurrent BCCs should be discussed by an MDT so that every patient's treatment follows best practice.
Ms Anna De Leo trained within NHS plastic surgery departments in London and Oxford and works in line with this model. Where further treatment is needed — for example sentinel lymph node biopsy, imaging, radiotherapy or systemic therapy for advanced melanoma — she will ensure that you are referred promptly to the appropriate specialist team, whether NHS or private, and that your care is coordinated clearly.
06Recovery and Follow-Up
Most skin cancer surgery is carried out as a day case under local anaesthetic, in an accredited London facility, and you can go home shortly afterwards. Discomfort is usually mild and controlled with paracetamol. Stitches are generally removed after five to seven days on the face and ten to fourteen days elsewhere.
- Keep the dressing clean and dry for the first 48 hours, or as instructed.
- Avoid strenuous exercise for one to two weeks, longer after larger reconstructions.
- Protect the scar from the sun with clothing and high-factor sunscreen for at least a year.
- Begin scar massage once the wound has healed; our scar therapy team can guide you.
After any skin cancer, regular skin self-examination is important, as having one increases the chance of another. Your follow-up schedule will depend on the type and stage of the cancer, and may be shared with your GP, dermatologist or MDT.
07Risks of Skin Cancer Surgery
Skin cancer surgery is generally safe, but every operation carries risks. These include bleeding and haematoma, infection, wound breakdown, a scar that is wider, raised or more visible than expected, partial loss of a flap or graft, numbness around the area and, on the face, temporary distortion of features such as the eyelid or lip. There is also a possibility of incomplete excision requiring further surgery, and of the cancer recurring despite clear margins.
Results vary from person to person. The first priority is always complete removal of the cancer; the second is the best achievable functional and cosmetic result. Before and after photographs of comparable reconstructions can be discussed at consultation to give you a realistic picture.
08Why Choose Ms Anna De Leo on Harley Street
Ms Anna De Leo is a GMC-registered Plastic, Reconstructive and Aesthetic Surgery Consultant and a Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery (FEBOPRAS), with more than twenty years of experience. Her NHS training includes Chelsea and Westminster Hospital, the Royal Free Hospital in London and Oxford University Hospitals, and she is a member of BAPRAS.
As a female plastic surgeon with a reconstructive and microsurgical background, she combines oncological thoroughness with the fine detail needed to reconstruct the face and other visible areas. If you are concerned about a changing mole or a non-healing spot and are looking for a skin cancer surgeon in London or near Marylebone, please arrange a prompt assessment on Harley Street. For benign moles, cysts and lumps, see our skin surgery page.
