Editing Skin excisions general (section)

== Dealing with positive margins ==

* Re-excise when possible
** Especially SCC positive at any margin, melanoma positive at any margin
** BCC positive at deep margin should be re-excised
** If a flap was used, generally take it down as soon as possible, and re-excise the relevant area. If it's left for a while, will need to take the deeper part of the flap too.
** If the margin was macroscopically normal at original surgery, and was performed by an experienced skin cancer surgeon, it is very hard to establish where the tumour is. Either a large re-excision will need to be done or the patient should have Moh's micrographic surgery with a plastic surgeon.
* Radiotherapy - where adequate excision may cause unacceptable cosmetic deformity, patient does not want further surgery, or as a primary treatment in non-surgical candidates
* Observation may be considered in some patients
** Pre-malignant lesions
** BCCs positive at a lateral margin (not a deep one) - recurrence rate about 50%, but it will be visible