If Surgery Doesn't Remove It All, — What Happens Next

A positive margin means the pathologist found cancer cells at the very edge of the skin tissue your surgeon removed. It does not tell you how much cancer might be left, only that the edge wasn't completely clear. Your tumour board will look at where this was found — the depth, the location, and the type of skin cancer — before deciding the next step. For many people, this leads to a second surgery to remove a bit more tissue from that same area. For others, especially if the spot is hard to reoperate on, radiation may be used instead. Either way, this is a normal part of skin cancer care, not a rare or worrying complication.

Not always, but it is common. If your surgeon can safely remove more tissue from the same area, a second surgery — sometimes called a re-excision — is often the first choice, since it can clear the remaining cancer cells in one more procedure. If the location makes further surgery difficult, such as close to the eye, ear or nose, your team may recommend radiation to that spot instead. The right choice depends on where your cancer is, how deep it went, and your own health. Ask your surgeon directly which option they would recommend for your specific report.

Yes, for some patients. Immunotherapy is generally kept as an option for skin cancers that are harder to treat with surgery or radiation alone, such as ones that have spread further or come back after other treatments. It works differently — it helps your own immune system attack cancer cells — so your team may add it if surgery and radiation don't fully control the cancer. Not everyone is a candidate; this depends on the type of skin cancer and how it has behaved. Your oncologist will tell you honestly whether it fits your case rather than treating it as an automatic next step for everyone.

Not necessarily. Needing a second surgery or radiation after a positive margin usually means a small number of cells were missed at the edge, not that your cancer has become more advanced. Many people with early skin cancers go through this exact sequence and do well afterward. It reflects how surgery works — the surgeon removes what can be seen and felt, and the lab checks the edges afterward — rather than a change in how serious your cancer is. If your team does find something more concerning during this process, they will tell you clearly and explain what it changes for your plan.

Your team will schedule regular follow-up visits to check the treated area and nearby skin, and they will tell you what to watch for between visits based on your specific case. Common things to mention early include a new lump, a sore that won't heal, or a change in a scar or nearby mole. You do not need to wait for a scheduled appointment if you notice something new — call your team and get it checked. Catching a change early keeps your options open, including simpler treatment, so don't hesitate over something that turns out to be nothing.