The area around the skin cancer will be cleaned. The skin cancer will be marked, using a sterile marking pen. A local anesthetic (Lidocaine) will be injected into the area. Usually there is some minor discomfort. Numbness should occur within about ten minutes.
A small layer of tissue will be removed and a map of it made. The small amount of bleeding that may occur will be stopped with a cautery unit and a dressing will be placed on the wound. You will be escorted back to the waiting room for approximately 45 minutes while the tissue is being processed.
During this time, the tissue will be frozen, stained, and cut for microscopic slides, which will be reviewed under the microscope by your doctor. A microscopic map will be made of any tumor remaining; this will pinpoint the exact location of any residual tumor, which would then be removed without having to remove any normally appearing skin.
You will then be escorted back into the procedure room for the second stage, given a little more anesthetic, and the process is repeated. Sometimes three or four stages are necessary to make sure that all affected tissue is removed.
Following this, a decision will be made as to the best method to repair the wound, which will depend on its size and location. It may be allowed to heal by itself, closed side-to-side with sutures, or be closed using a local flap or graft. Although some wounds are repaired on the day of surgery, most are allowed to heal partially before reconstruction during the follow up appointment. In some cases, unique skills of other specialists may also be required, in which case, the reconstruction will be done later that day or on a subsequent day.