Skin cancer surgery: removing it properly — and leaving a face you can live with

First — and this is the most important thing you will read here

A skin cancer is not erased with a laser. Ever.

This has to be said plainly, because it is where people are lost: if a lesion is, or might be, a cancer, vaporising it with a laser or burning it destroys precisely the tissue the pathologist needs in order to say what it was and whether it came out whole. The lesion disappears from view, the patient goes home reassured, and the tumour keeps growing underneath — now with no diagnosis, no margins and no timeline. Months later it returns, larger and harder.

Anyone offering to "take that odd mole off with a laser" without studying it first is offering to destroy the evidence. That is not an opinion: it is the reason histopathology exists.

Here the order is not negotiable: suspect, study, then operate. And if the study says it is not cancer, it is not operated on — which happens, and is good news.

Who does what: the honest question

This matters, and on this site it is spelled out by name, because some clinics blur it:

That both halves happen under one roof — the clinic was founded in 1971 and has its own laboratory — is what stops a patient spending weeks bouncing between a practice that diagnoses and another that operates. In a skin cancer, those weeks are part of the treatment.

• Suspicion, screening and diagnosis belong to the clinic’s dermatology consultation, founded in 1971 by the dermatologist Dr. Francisco Arellano Ocampo.
• Histopathology is done by the pathologist. He is the one who says what the tumour is and whether the margins came out clear. Neither the surgeon nor the dermatologist can decide that by looking.
• The surgery — excision, margins and reconstruction — is performed by Dr. Arístides Arellano Huacuja, plastic and reconstructive surgeon (specialty licence 0002008). He is not a dermatologist, and on this site each person appears with the specialty they actually hold.
• Where a case exceeds surgical-dermatologic territory — a melanoma meeting criteria for multidisciplinary oncologic management, for instance — the clinic diagnoses, orients and refers, with the information in hand. A serious institution is measured by what it does when a case leaves its territory.

What is operated on, and why the tumour type changes everything

Under the label "skin cancer" sit tumours with very different behaviours, and the surgical plan is not the same:

The margin — how much healthy tissue comes out around the tumour — is dictated by the type and size of the tumour, not by how convenient the closure is. It is the line separating oncologic surgery from a cosmetic procedure, and it is the line that is not crossed.

• Basal cell carcinoma — by far the most common. It grows locally, rarely metastasises, but invades and destroys what surrounds it: left for years on a nasal ala or an eyelid, it eats the structure. Full page: basal cell carcinoma.
• Squamous cell carcinoma — more aggressive than basal cell, with a real capacity to spread. It demands wider margins and closer follow-up.
• Melanoma — the least common and the one that kills. The margin depends on thickness (Breslow), which is only known after the biopsy. It may require multidisciplinary oncologic management, and in that case it is referred. A melanoma is never treated with a laser or electrodesiccated.
• Precancerous lesions (actinic keratosis) — not always operated on. Many are treated medically. See actinic keratosis.

Reconstruction: the half almost nobody explains beforehand

When the tumour comes out, a hole is left. On the face. And what is done with that hole is what the patient will see in the mirror for the rest of their life.

That is precisely why this operation is done by a plastic and reconstructive surgeon and not by anyone who can cut. Reconstruction is not "stitching": it is choosing, among several options, the one that restores function and form in that particular aesthetic unit.

The decision is made with the defect already open and — where the case demands it — with the margin already confirmed. In high-risk lesions, closing a defect elaborately before knowing whether the margin came out clear is an expensive mistake: if a re-excision is needed, the reconstruction is destroyed. In those cases the wound is closed provisionally, the result is awaited, and reconstruction follows. It is slower, and it is correct.

All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.

• Direct closure, where local laxity allows it and the scar can be hidden in a natural line.
• Local flaps — neighbouring skin, with its own blood supply, is mobilised to fill the defect with tissue of the same colour and thickness. This gives the best result on the face. See grafts and flaps.
• Skin grafts, where there is not enough neighbouring tissue. They survive, but they almost always show more than a flap: different colour, different texture.
• Aesthetic-unit reconstruction — on the nose, eyelid and lip, the best scar is sometimes obtained by reconstructing the whole subunit rather than patching the defect.

The sun of thirty years ago

Almost everything operated on here is the bill for sun exposure accumulated across decades, not for last summer. That is why it appears in people over 50, and why it appears on the face, the ears, the bald scalp and the backs of the hands — the areas that were never covered.

And that is why one sentence is worth hearing even though it sells no surgery: anyone who has already had one skin cancer is at high risk of having another. Annual follow-up is not a commercial extra; it is part of the treatment. Operating on a basal cell and never being checked again is doing half the job.

Cost is defined at the consultation — it depends on the tumour, its size, its site and the reconstruction it requires. See the price list.

See the full guide: Post-surgical recovery and care.

Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.

Documented training in skin-cancer surgery

The surgeon who excises a skin cancer must know how to close what was opened: grafts, flaps, and a face that still looks like a face. Dr. Arístides Arellano is fully licensed — professional and specialty cédula — and was an invited speaker on reconstructive surgery for skin cancer:

• Speaker invitation — Argentine Society of Dermatologic Surgery — Curso: cirugía reparadora en cáncer de piel · Buenos Aires, 2020
• Speaker: surgical treatment of skin tumors — Jornada de Alergia, Dermatología y Cirugía Estética · BUAP, noviembre de 1996
• Symposium: cutaneous substance loss — Instituto Marcelo J. Fitte · Buenos Aires
• Article: Surgical treatment of facial mycetoma — Medicina Cutánea I.L.A., Vol. XVII, 1989 · Orellano, Arellano, León
• Fellow — International Society for Dermatologic Surgery — Nueva York · abril de 1991

Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.

Recovery · step by step

• Before — the studyThe lesion is assessed and studied. What has not been studied is not operated on, and a suspicious lesion is not destroyed with a laser: that erases the evidence the pathologist needs.
• Day 0 — the surgeryExcision with margins, usually under local anaesthesia and as a day case. The specimen goes intact to histopathology. Depending on risk, reconstruction is done in the same operation or deferred until the margin is confirmed.
• Days 1–7Dressings. Swelling and bruising at the site. Facial sutures come out early — usually between day 5 and 7 — precisely so that the scar is better.
• The pathology resultIt says what it was and whether the margins came out clear. If they did not, the excision is widened. It is inconvenient, and it is exactly why high-risk lesions are not elaborately reconstructed before it is known.
• Weeks 2–8The scar goes through its worst phase: red and firm. This is not the result. Strict photoprotection over the scar, which is what most influences how it ends up.
• Months 6–12The scar matures and pales. This is when the result is judged — not before.
• Follow-up — for lifeAnyone who has had one skin cancer is at high risk of another. Periodic review at the dermatology consultation. Not an extra: part of the treatment.

Frequently asked questions

Every figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.

Educational content; it does not replace a medical consultation. Results may vary from person to person.