Skin cancer is one of the most common malignancies worldwide, and its incidence is steadily rising in Singapore due to increased sun exposure and an ageing population. Fortunately, with early detection and appropriate treatment, most skin cancers can be effectively managed. A key component of successful treatment lies not only in the surgical technique but also in the choice of anaesthesia.

There’s a common misconception that general anaesthesia is used in every surgical procedure, but this isn’t always the case, especially with skin cancer surgeries, which vary in complexity. For patients seeking care from a Gleneagles dermatologist or a skin cancer surgeon, understanding the different anaesthesia options available can help alleviate anxiety and support informed decision-making.

Types of anaesthesia in skin cancer surgery

Skin cancer surgery is typically performed on an outpatient basis and is often less invasive than other forms of cancer surgery. As such, the majority of procedures can be safely and effectively carried out under local anaesthesia. However, depending on the complexity of the case, patient preference, and medical history, other anaesthetic options may be considered. The three main types of anaesthesia used in skin cancer surgery are:

1. Local anaesthesia

Local anaesthesia involves injecting an anaesthetic agent (most commonly lignocaine or lidocaine) directly into the skin around the surgical site to numb the area. The patient remains fully awake and alert during the procedure but does not feel pain in the targeted region.

This is the most commonly used form of anaesthesia in skin cancer surgery and is particularly suitable for:

• Small to moderate-sized lesions
• Areas with minimal surgical complexity
• Patients who are medically fit and prefer to avoid sedation

One of the key advantages of local anaesthesia is its safety profile. It avoids the risks associated with sedation or general anaesthesia, allows for a quicker recovery, and enables patients to return home shortly after the procedure. Because patients are awake, it allows the surgeon to communicate with them throughout the surgery, keeping them updated on any developments.

For many patients treated by a skin specialist in Singapore, local anaesthesia is the preferred option due to its simplicity and effectiveness. It allows skin cancer surgeries to be performed in the clinic, which reduces costs and brings greater value for patients. To note, surgeries performed in clinics are often still counted as day surgeries and may be claimable from insurance as such.

Pain is usually mild to moderate after local anaesthesia wears off, and can be easily managed with painkillers. Patients who drive can often drive themselves home after surgery.

2. Local anaesthesia with sedation

In some cases, patients may experience anxiety or discomfort at the thought of being awake during surgery. For these individuals, local anaesthesia can be combined with sedation. Sedation is administered intravenously and helps the patient feel relaxed or drowsy, while the surgical site remains numb.

This approach is often used for:

• Larger or more complex skin cancers
• Sensitive anatomical areas (e.g., around the eyes or lips)
• Patients with anxiety or low pain tolerance

Sedation can range from minimal (where the patient is relaxed but awake) to moderate (where the patient may fall into a light sleep but can still respond to verbal cues). Sedation may be administered in the clinic, or more commonly in the operating theatre. A trained anaesthetist typically monitors the patient throughout the procedure to ensure safety and comfort. There may be a short period of observation in the recovery room before the patient may be discharged. Driving is not recommended after sedation.

3. General anaesthesia

General anaesthesia renders the patient completely unconscious and is typically reserved for more extensive procedures or when local anaesthesia is not feasible. While rarely needed for skin cancer surgery, it may be considered in the following scenarios:

• Very large or deep tumours requiring complex reconstruction
• Multiple lesions requiring prolonged surgery
• Patients with special needs or severe anxiety
• Children who may not cooperate under local anaesthesia

General anaesthesia carries more risks and requires a longer recovery period. It is usually administered in a hospital setting under the care of an anaesthesiologist. For most patients, however, general anaesthesia is not necessary, and less invasive options are sufficient.

A few key factors help determine the most appropriate anaesthesia type for skin cancer surgery. Your skin cancer surgeon and anaesthetist will work together to assess the surgical plan and your personal medical background. These decisions are made to maximise safety, comfort, and outcomes.

Mohs micrographic surgery: The gold standard

Among the various surgical techniques available, Mohs micrographic surgery stands out as the gold standard for treating certain types of skin cancer, particularly basal cell carcinoma and squamous cell carcinoma. This highly specialised procedure is designed to remove the cancer layer by layer while preserving as much healthy tissue as possible.

A key feature of Mohs surgery is that it is always performed under local anaesthesia. This is because:

• The procedure is meticulous but minimally invasive
• The surgery is often performed in stages, with tissue examined under a microscope between each stage. Patients under local anaesthesia will be able to wait outside the operating room while waiting in between stages, compared to being under general anaesthesia for prolonged periods.
• As Mohs surgery is performed in stages, the patient can be updated in real time on the depth and size of the defect after the skin cancer is removed. He or she may then discuss with the Mohs surgeon the options of reconstruction (closing the defect on the skin). In general anaesthesia, the type of reconstruction has to be decided before the patient is rendered unconscious, with no avenue to changing one’s mind even if circumstances change during the surgery.

Mohs surgery offers the highest cure rates – up to 99% for certain skin cancers – while minimising scarring and preserving function. For patients seeking a skin cancer surgeon in Singapore, Mohs surgery is often recommended for cancers located on cosmetically or functionally sensitive areas such as the hands, ears, or face.

Choosing the right anaesthesia: What to expect

When consulting a dermatologic surgeon or dermatologist in Singapore, the choice of anaesthesia will be tailored to the individual’s needs. Factors that influence this decision include:

• Size, type, and location of the skin cancer
• Patient’s medical history and current medications
• Anxiety levels and personal preferences
• Duration and complexity of the procedure

During the pre-operative consultation, your doctor will explain the anaesthesia options and help you choose the most appropriate one. Most patients are pleasantly surprised by how comfortable and straightforward skin cancer surgery can be under local anaesthesia.

Patients may also be reassured that in most circumstances, skin surgery performed in the clinic will still be claimable from their insurance, without the need for a lengthy or costly admission to the hospital.

Conclusion

Skin cancer surgery has evolved significantly, with modern techniques offering excellent outcomes and minimal discomfort. For the vast majority of patients, local anaesthesia provides a safe, effective, and convenient option. In select cases, sedation or general anaesthesia may be used to enhance comfort or accommodate complex procedures.

Mohs micrographic surgery, in particular, exemplifies the precision and efficacy of modern dermatologic surgery, and it is always performed under local anaesthesia. Whether you are seeing a dermatologist for a suspicious lesion or undergoing treatment with a skin cancer surgeon, understanding your anaesthesia options can empower you to make informed decisions and approach your care with confidence.

At TSN Dermatology Skin Specialist Clinic, we offer comprehensive skin cancer care, including screening, diagnosis, and surgical treatment options such as Mohs micrographic surgery. If you’re concerned about a suspicious skin lesion or need expert advice, our team is here to guide you through every step with clarity and care. Book your consultation today.

References

Grekin, R. C., & Auletta, M. J. (1988). Local anesthesia in dermatologic surgery. Journal of the American Academy of Dermatology, 19(4), 599–614. https://doi.org/10.1016/s0190-9622(88)70213-3

Anesthesia: Types & what you should know. Cleveland Clinic. (2025, April 2). https://my.clevelandclinic.org/health/treatments/15286-anesthesia

Smith, G., D’Cruz, J. R., Rondeau, B., & Julie Goldman, J. (2023, August 5). General anesthesia for surgeons. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493199/