A Big Opportunity for surgery's next generation

If you're a junior doctor or surgical trainee looking to build your skills, don't underestimate the value of minor ops and minor skin cancer surgery. While these procedures may seem basic, they provide one of the most important platforms to develop core surgical principles—especially in oncological care.

Here is what you should know:

🔍 Know the Basics: Understand Your Enemy

Common skin cancers you’ll encounter include:

• Basal Cell Carcinoma (BCC) – Slow-growing, low metastatic risk

• Squamous Cell Carcinoma (SCC) – Higher metastatic potential

• Melanoma – Aggressive and fast-spreading; early recognition is critical

Early and accurate excision matters—both for diagnosis and definitive treatment.

✂️ Get Your Margins Right

Diagnostic vs. Therapeutic excision:

• Diagnostic excision: 1–2mm margin with a cuff of fat

• Therapeutic excision: Wider margins based on cancer type:

  • BCC: 4–5mm

  • SCC: 4mm–1cm depending on aggression

  • Suspected melanoma: Start with a diagnostic excision to determine Breslow thickness

Always aim for oncological clearance with minimum recurrence risk. A dermatoscope and good lighting can significantly improve your margin assessment.

💉 Master Local Anesthesia

Administer your anesthetic parallel to sensory nerves, not directly into the lesion. Allow time for adrenaline to take effect before starting. This optimizes patient comfort and improves hemostasis.

🔪 Surgical Pearls

Follow these practical tips to avoid contaminating healthy tissue and ensure sound oncological practice:

• Use separate needles for each lesion

• Prep normal skin before tumor

• Use skin hooks instead of crushing forceps

• Use fresh instruments for closure

• Fresh sutures per lesion = lower contamination risk

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📐 Scar Orientation Matters

Your closure plan should respect local anatomy:

• Limbs: Go vertical—preserves lymphatics, reduces swelling

• Face: Start with circular excision; facial elasticity allows for smart closure without long ellipses

• Lower eyelid: Avoid transverse scars—risk of ectropion

• Trunk: Follow Resting Skin Tension Lines (RSTLs)

• Post-auricular area: Skin grafts may reveal recurrence earlier in high-risk tumors

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🧠 Think Mohs for High-Risk Areas

Mohs micrographic surgery offers precise margin control and should be considered for:

• Aggressive BCCs (morphoeic, infiltrative)

• Tumors on the nose, eyelids, and ears

• Recurrent lesions

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Final Word: Make the Most of the Minor

Minor ops are not minor in impact. They’re a golden opportunity to learn how to:

✅ Handle tissue respectfully✅ Think like an oncologic surgeon✅ Plan aesthetically appropriate closures

Early confidence in these skills lays the foundation for your future in surgery.

Ready to sharpen your skills?Check out structured skills videos at www.medsyncltd.com/skills.