If your GP or dermatologist has just told you that a spot needs to come off, or that a biopsy has come back as melanoma, you’re probably wondering what actually happens next. Removal is only half the story. What happens to the skin left behind, and how it’s repaired, matters just as much for how you heal and how you look afterwards.
This guide covers the main types of skin cancer, how they’re typically removed, the reconstruction options available once the cancer is out, and when it’s worth seeing a plastic surgeon rather than having everything done by your GP. It’s written for Queenslanders, because if there’s one place in the world where this topic is relevant, it’s here.
Skin cancer in Queensland: why it matters
Queensland has, somewhat famously, been called the skin cancer capital of the world, and the data backs it up. Melanoma incidence in Queensland runs around 40% higher than the national average, translating to roughly 71 cases per 100,000 people, a rate that outstrips almost every other place on earth. More than 3,600 Queenslanders are diagnosed with melanoma each year, on top of hundreds of thousands of non-melanoma skin cancer treatments.
Zoom out to the national picture and the numbers are still striking. At least two in three Australians will be diagnosed with some form of skin cancer by the time they turn 70. For 2025, the Australian Institute of Health and Welfare projects around 17,443 new cases of melanoma across the country. Given our climate, our outdoor lifestyle and, frankly, a lot of sun damage accumulated well before sunscreen habits caught on, it’s little wonder plastic surgeons in Brisbane see so much of this work.
None of this is meant to alarm you. Most skin cancers, including most melanomas caught early, are highly treatable. But it does explain why skin cancer surgery and reconstruction is such a routine, well-understood part of practice here, rather than a rare or experimental corner of medicine.
The main types of skin cancer
Basal cell carcinoma (BCC)
BCC is the most common form of skin cancer and, thankfully, the least aggressive. It tends to grow slowly and rarely spreads beyond the skin, but left untreated it can still burrow into surrounding tissue, which is why removal is still recommended even for small, seemingly harmless lesions.
Squamous cell carcinoma (SCC)
SCC also arises from sun-damaged skin cells and is more likely than BCC to grow quickly or, in a small proportion of cases, spread to nearby lymph nodes. It often appears as a scaly, crusted or ulcerated spot, and it’s generally treated with a bit more urgency than a typical BCC.
Melanoma
Melanoma starts in the pigment-producing cells of the skin and, although it’s far less common than BCC or SCC, it’s the one that carries the highest risk of spreading elsewhere in the body if it isn’t caught in time. This is exactly why any new or changing mole deserves prompt attention, and why melanoma surgery is planned with wider margins and more caution than other skin cancers, which is explained further down.
How skin cancers are removed
Excision and wide local excision
Most skin cancers are removed by excision: cutting out the visible lesion along with a border of surrounding, apparently normal skin. For BCC and SCC, this border is usually modest. For melanoma, the same principle applies but the border, known as the margin, is deliberately wider, and the procedure is often called a wide local excision.
Surgical margins and why more skin is removed
It might seem counterintuitive to remove healthy-looking skin along with the cancer, but microscopic cancer cells can extend beyond what’s visible to the eye. Taking a margin gives the pathologist the best chance of confirming that all the cancer has actually been cleared.
For melanoma specifically, Australian evidence-based guidelines set out how wide that margin should be, based on how deep the melanoma has grown (its Breslow thickness):
- Melanoma in situ (the earliest, non-invasive stage): 5 to 10mm margin
- Invasive melanoma up to 1.0mm thick: 1cm margin
- Invasive melanoma 1.01 to 2.0mm thick: 1 to 2cm margin
- Thicker melanomas (2 to 4mm): up to 2cm margin
These aren’t arbitrary numbers. They come from decades of clinical trials looking at recurrence rates, and they’re the reason your surgeon might recommend removing more tissue than you expected from a spot that looked quite small.
Sentinel lymph node biopsy for melanoma
For some melanomas, particularly those of a certain thickness, your surgical team may also recommend a sentinel lymph node biopsy. This involves identifying and removing the first lymph node, or nodes, that melanoma cells would travel to if the cancer had started to spread, and checking it under the microscope. It’s a staging tool rather than a treatment in itself, and it helps your care team understand the full picture and plan any further treatment accordingly.
Reconstruction options after removal
Once the cancer has been removed, the wound needs to be closed. Plastic surgeons often think of this in terms of a “reconstructive ladder,” starting with the simplest option that will do the job well, and moving to more complex techniques only when needed.
Direct (primary) closure
The simplest option: the edges of the wound are brought together and stitched directly, similar to closing any surgical incision. This works well for smaller defects where there’s enough nearby skin laxity to close without tension or distortion.
Skin grafts
When a defect is too large to close directly, a skin graft may be used. A thin layer of skin is taken from another part of the body, often the thigh, and placed over the wound like a patch. The graft has no blood supply of its own initially; it relies on the wound bed underneath to nourish it while new blood vessels grow in, which usually happens over the first one to two weeks.
Local skin flaps
A local flap is a different approach: nearby skin and its underlying tissue are lifted and rearranged to cover the defect, while keeping their own blood supply intact. Because a flap brings its own blood vessels with it, and because it’s often a very close match in colour, thickness and texture to the skin around it, flaps frequently give a better cosmetic result than a graft, particularly on visible areas.
Reconstruction on the face
Facial reconstruction deserves its own mention, because the stakes here are different. The face is made up of distinct aesthetic units, the nose, cheeks, eyelids, lips, and even a well-executed closure can look wrong if it distorts one of these boundaries or pulls a feature like an eyelid or lip out of position.
This is where a plastic surgeon’s training in flap design really counts. Techniques like advancement, rotation or rhomboid flaps are chosen and shaped specifically to respect these boundaries, hide scars along natural creases where possible, and preserve normal function, particularly around the eyes and mouth. It’s a different skill set to removing the cancer itself, which is one reason plastic surgeons are so often involved in this stage of care.
Healing, scars and what to expect afterwards
Healing timelines vary depending on the technique used. Both donor and grafted sites typically begin healing within one to two weeks, though the skin will look pink and slightly raised for a while afterwards. Flap sites tend to settle over a similar early timeframe, with the fine detail of the scar continuing to improve over several months.
Scars from skin. cancer surgery, whether from direct closure, a graft or a flap, generally mature and fade over roughly twelve to eighteen months. Early on, a scar can look red, firm or more obvious than you’d like, and that’s normal. Sun protection over the healing scar matters more than people expect, since UV exposure can affect how a scar settles and pigments over time.
When to see a plastic surgeon rather than a GP
Plenty of small, straightforward BCCs and SCCs are removed very capably by GPs with skin cancer training, and that’s entirely appropriate for a lot of cases. A referral to a plastic surgeon becomes more relevant when the lesion is on the face or another cosmetically or functionally sensitive area, when the defect after removal is likely to be large or complex, when a flap or graft is anticipated rather than a simple closure, or when melanoma is confirmed or suspected and a wide local excision with possible sentinel node biopsy is being planned. If you’re ever unsure, it’s a reasonable question to ask your GP directly: is this something you’re comfortable handling, or should I see a specialist?
Why choose Dr Perron for skin cancer and melanoma surgery in Brisbane
Dr Justin Perron is a Specialist Plastic and Reconstructive Surgeon who completed his Australian Fellowship in Plastic and Reconstructive Surgery with the Royal Australasian College of Surgeons (FRACS). His training took him from South East Queensland to Perth in Western Australia, and his clinical work has spanned much of Queensland, from Townsville to Brisbane, Redcliffe, Caboolture and the Gold Coast, in a region with some of the highest skin cancer rates on the planet.
Dr Perron presents at surgical conferences and has published in peer-reviewed journals, keeping his practice current in a field that continues to evolve. He operates at Wesley Hospital, St Andrews War Memorial Hospital, Brisbane Private Hospital and Spring Hill Specialist Day Hospital, and consults from private rooms at Herstellen Clinic, 490 Boundary Street, Spring Hill, Brisbane.
That combination, extensive experience in a genuinely high-incidence region, plus specific training in reconstructive technique, matters most when a skin cancer sits somewhere cosmetically or functionally sensitive, such as the face, or when a defect calls for a flap rather than a simple closure. Dr Perron works through each case individually, from planning the excision through to closing the wound in a way that aims to protect both function and appearance.
You can read more about his background and credentials on his FRACS profile, through the Australasian Society of Aesthetic Plastic Surgeons, on RealSelf, via the AU & NZ Board of Cosmetic Surgery, on Plastic Surgery Hub, or on his own about page.
If you have a skin cancer or melanoma diagnosis and would like to discuss your reconstruction options, book a consultation with Dr Perron. You will need a referral from your GP or treating specialist to be seen.
Frequently asked questions
What is the difference between a skin graft and a skin flap?
A skin graft moves skin without its own blood supply from a donor site to cover the wound. A local flap moves nearby skin while keeping its blood supply attached, which often gives a better colour and thickness match.
How serious is melanoma surgery?
Melanoma surgery itself, a wide local excision, is a well-established and generally safe procedure. The seriousness lies less in the operation and more in the underlying diagnosis, which is why margins are wider and follow-up is more structured than for other skin cancers. Your surgical team will explain your specific risk based on the thickness and features of your melanoma.
Will I need reconstruction after skin cancer removal?
It depends on the size and location of the defect. Many smaller excisions are closed directly with stitches and need no further reconstruction. Larger or more complex defects, especially on the face, may need a skin graft or flap to close well and heal with a good functional and cosmetic result.
How long does a skin graft take to heal?
Both the donor site and the grafted area typically begin healing over one to two weeks, with the surrounding redness and texture continuing to settle, and scars fading further over the following months.
Why is a plastic surgeon involved in skin cancer treatment?
Plastic surgeons bring specific training in reconstructive techniques, flap design and aesthetic outcomes, which becomes particularly valuable for larger defects, facial surgery, or cases where the closure needs to preserve both appearance and function.
What are the margins for melanoma removal?
Margins are based on how deep the melanoma has grown: 5 to 10mm for melanoma in situ, 1cm for invasive melanoma up to 1.0mm thick, 1 to 2cm for melanoma 1.01 to 2.0mm thick, and up to 2cm for thicker melanomas between 2 and 4mm.
Please be advised that all procedures carry risks, therefore, we encourage patients to consult with their regular GP and Qualified Specialist Plastic Surgeon before considering surgery.
Further reading
Medical references
- Cancer Council NSW, Surgery for Melanoma
- Cancer Council, Surgery for Skin Cancer
- Melanoma Institute Australia, Melanoma facts and statistics
- healthdirect Australia, Skin cancer and melanoma
- Therapeutic Goods Administration, Sunscreen regulation and standards
- Cleveland Clinic, Skin Graft
