What are facial skin lesions?

Facial skin lesions are areas of skin on the face that look different from the surrounding skin. They may be benign (harmless) such as moles, cysts or skin tags, or they may be skin cancers such as basal cell carcinoma, squamous cell carcinoma or melanoma. Not all lesions need treatment, but changes over time or symptoms like bleeding warrant evaluation.

When should I consider removal of a lesion?

You may be advised to remove a lesion if it:

  • changes size, shape or colour

  • ulcerates, bleeds or becomes painful

  • shows features suspicious for skin cancer

  • irritates daily life (e.g., gets caught on glasses/clothing)
    In many cases, a biopsy or surgical removal is recommended to confirm the diagnosis and ensure complete treatment.

How is a facial lesion or skin cancer removed?

Most removals are done under local anaesthetic as a day case, meaning you’ll be awake but the area is numbed so you won’t feel pain. The surgeon excises the lesion with a margin of normal skin to ensure complete removal. The wound may be closed with stitches, a flap of local skin, or a skin graft depending on size and location.

Will I need general anaesthetic?

Most small or medium skin cancers are treated under local anaesthetic. General anaesthetic may be offered if the area is large, complex or near critical structures (e.g., eyelids, lips), or if you prefer to be asleep. These decisions are made together with you after evaluation.

What about biopsy, is that different from removal?

A biopsy involves removing part or all of a lesion to send for microscopic examination. It helps confirm whether a lesion is benign or cancerous before planning definitive surgery. Techniques include shave biopsy, punch biopsy or excisional biopsy depending on location and suspected diagnosis.

Are there alternatives to surgical excision?

For benign lesions or very superficial skin changes, other options may include:

  • Cryotherapy (freezing)

  • Laser or shave excision

  • Topical treatments for pre-cancerous changes
    However, suspicious or cancerous lesions usually require surgical excision to ensure complete removal.

What happens on the day of surgery?

You will usually have a pre-assessment to confirm your fitness. On the day, local anaesthetic is given and the area is cleaned and marked. The lesion is excised, and your surgeon repairs the wound with stitches, a flap, or graft as needed. Most procedures are outpatient or same-day discharge.

Will it hurt?

The surgical area is numbed with anaesthetic so you shouldn’t feel pain during the procedure. Some initial stinging with the anaesthetic injection is normal, but this passes quickly. After the surgery, there may be mild discomfort, swelling or bruising which is managed with standard pain relief.

What about scarring?

All surgical procedures result in a scar. Surgeons aim to place incisions in natural skin lines and use techniques to minimise visible scarring. Scars fade over time, especially with appropriate care, sun protection and follow-up. More complex reconstruction (e.g., flaps) may initially look more noticeable but generally improve with healing.

Is further treatment needed after removal?

If the lesion is cancerous, the excised tissue is examined by a pathologist to confirm that all cancer has been removed. Sometimes wider surgery or additional treatments are recommended based on findings. Your surgeon discusses follow-up plans with you.

Can facial skin cancers be treated with Mohs surgery?

In select cases especially when maximising normal tissue preservation is important (e.g., around the eyes or nose) a specialised technique called Mohs micrographic surgery may be considered. It involves removing skin in layers and microscopically checking margins until all cancer cells are gone, reducing recurrence and preserving healthy tissue.

How long does recovery take?

Healing times vary with the procedure and location but typically:

  • Simple excisions: a few days to a couple of weeks of swelling/redness

  • Larger excisions with flaps/grafts: longer recovery with closer follow-up
    Your surgeon gives personalised aftercare guidance, including dressings and activity advice.

    Tips for Patients Considering Treatment

  • Monitor skin changes using the ABCDEs (Asymmetry, Border irregularity, Colour variation, Diameter, Evolving).

  • Seek medical evaluation if a lesion changes or causes symptoms.

  • Discuss expected cosmetic outcomes and scar-minimising approaches with your surgeon before treatment.

  • Use sun protection to reduce future skin damage risk.