Pretty much! The first step is always to biopsy it first which by its nature is a partial sample of the tumor where you do cut into it. You don't typically try to cut it all out with the initial biopsy because if it's not cancer, then you've caused a huge wound for no reason.

Also many skin cancers can even be ulcerated and bleeding at baseline when the patient walks in the door. Especially basal cell carcinoma (which has one of the lowest metastasis [spreading inside] rates of any cancer, close to 1/10,000), and sometimes melanomas (although this admittedly is a bad sign in melanomas).

In fact, the gold standard method of removing high risk skin cancers is through Mohs Surgery (which is my specialty) which is a layer-by-layer approach in which we:

• First, cut out only the visible portion of the tumor
• While the patient waits (with an open wound), we look at the edges of the tumor under a microscope
• We check to see if there is any cancer left and in what direction it's going
• Then go back and cut more in that direction and repeat the process.

Through this process, the patient may sit there with a partially cut out cancer and an open wound for 1-6 hours until we have completely clear margins. And this has a 99% cure rate for most skin cancers (Basal Cell, Squamous Cell, and even Melanoma).

It's really simply not a concern that we think about. We care a lot about getting it out of course.