Skin surgery and when to see a plastic surgeon

May is Skin Cancer Awareness Month, and it is a timely reminder that skin cancer is now the most common cancer diagnosed in England. According to NHS data published by the British Association of Dermatologists, there were over 224,000 skin cancers recorded in England in 2019 alone – a figure that has risen by more than 26% in just six years. Behind each of these numbers is a patient facing a diagnosis, a decision about treatment, and questions about what surgery might involve and who should perform it.

As a Consultant Plastic and Reconstructive Surgeon, Mr Juling Ong sees patients at all stages of this journey. Some are referred directly by their GP or dermatologist for surgical excision. Others come having already had a diagnosis confirmed and want to understand their options for reconstruction, particularly when the lesion is on the face or hands – areas where both function and appearance matter enormously.

Here, we look at what skin surgery involves, what patients can expect and why choosing a surgeon with expertise in reconstruction and scar management makes a meaningful difference.

Understanding the most common skin cancers

The three principal types of skin cancer patients present with are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma.

BCCs are the most frequently diagnosed skin cancers and typically arise on sun-exposed skin, particularly the face, scalp, and ears. Although BCCs rarely spread beyond their original site, inadequate removal can lead to local recurrence and, on the face, to significant scarring and functional disruption if not carefully planned.

SCCs are the second most common type and carry a greater risk of spreading if left untreated. A peer-reviewed UK epidemiological study published in the British Journal of Dermatology found that cutaneous SCC incidence has increased substantially across the UK between 2013 and 2018, and the condition can present on the face, lips, ears, and hands.

Malignant melanoma, though less common, is the most serious form of skin cancer. Cancer Research UK data shows that around 15,400 people are diagnosed with melanoma in the UK each year, with incidence rates having increased by more than 164% since the early 1990s. Early diagnosis and prompt surgical removal remain the cornerstone of effective treatment.

When should you see a plastic surgeon?

Not every skin lesion requires a plastic surgeon, but there are circumstances in which specialist reconstructive expertise becomes essential. You are advised seek a consultation with a plastic and reconstructive surgeon if:

• The lesion is located on a sensitive area of the face – the nose, eyelids, lips, or ears – where standard excision alone may not achieve a satisfactory functional or cosmetic outcome
• The tumour is large, recurrent, or has previously been incompletely removed
• Mohs micrographic surgery has been performed, and the resulting defect requires reconstruction
• The lesion is on the hand, where precision is critical to preserving movement and dexterity
• You have concerns about how the scar will heal and want the best possible outcome from the outset

Early referral is always preferable. The research is clear: stage one melanoma treated promptly carries a five-year survival rate of over 95% in England, whereas advanced disease is significantly harder to treat. Please do not wait if you have noticed a changing mole, a new growth, a persistent non-healing lesion, or any area of skin that looks or feels different.

What skin surgery involves

The type of surgery required depends on the tumour’s size, location, and depth. Smaller lesions are typically removed under local anaesthetic with a margin of healthy tissue, and the wound is closed directly with sutures. The tissue is then sent for histological analysis to confirm that the margins are clear.

Larger or more complex tumours may require reconstruction after excision. This could involve a local skin flap – where nearby tissue is rearranged to cover the defect – or a skin graft, where tissue is taken from another part of the body. When Mohs surgery has been used to remove the cancer layer by layer (a technique that is particularly valuable for facial lesions, as it minimises unnecessary tissue removal), Mr Juling Ong will often then provide the reconstruction once the Mohs surgeon has confirmed clear margins. General anaesthetic may be required for more extensive procedures.

Why surgical technique and scar management matter

Skin surgery always leaves a scar; this is unavoidable and is discussed with every patient during their consultation. However, the quality of the scar is not simply a matter of chance; it is directly influenced by surgical technique, tissue handling, suture placement, and aftercare.

On the face and hands, getting this right from the very first operation is critically important. Incisions planned along natural skin tension lines and the contours of the face heal far more discreetly than those that cut across them.

The choice of suture material, the layered closure technique, and the tension applied to the wound edges all influence the result. Juling’s training as a reconstructive surgeon, including his work at Great Ormond Street Hospital managing complex paediatric cases, underpins this approach to precision and attention to detail in every skin surgery procedure.

Following surgery, scar management may include silicone-based products, sun protection, and, in some cases, further scar treatment procedures. Juling works closely with each patient to monitor healing and offer guidance at every stage.

Complementing reconstructive facial surgery

Juling’s skin surgery work sits alongside a broader specialism in reconstructive facial surgery. For patients who require more extensive reconstruction following tumour removal – for example, where a significant portion of the nose, eyelid, or lip is affected – the same reconstructive principles that inform his facial work apply directly.

The goal is always to restore both function and form, preserving the integrity of the face in a way that reflects both the complexity of the surgery and the patient’s quality of life afterwards.

Concerned about a lesion? Please do not delay

If you have noticed a skin change that concerns you, or if you have already been advised that surgical removal is recommended, Mr Juling Ong would be glad to see you for a consultation. He practices at leading private hospitals in London and provides a thorough assessment of your lesion, a clear explanation of your surgical options, and an honest discussion of what you can expect from treatment and recovery.

Skin cancer is highly treatable when caught early. This Skin Cancer Awareness Month, please take any skin changes seriously and seek an expert opinion without delay.