Avoiding nerve injury in skin cancer surgery

In this episode of Life by A Thousand Cuts podcast, A/Prof Tony Dicker explores a critical topic for doctors surgically treating skin cancers: how to avoid accidentally cutting nerves during procedures.

A/Prof Dicker offers real-world strategies to help you plan safer surgeries. The discussion covers several major nerves relevant to skin cancer surgery, particularly in the head and neck region:

• Accessory nerve – Damage here can cause significant morbidity, including shoulder weakness and difficulty raising the arm. A/Prof Dicker explains how to identify its path along the sternocleidomastoid and when referral is the safer option.

• Temporal branch of the facial nerve – Injury can cause unwanted, asymmetric paralysis of the forehead. A/Prof Dicker shares a simple anatomical landmark and tips for safer anaesthesia.

• Marginal mandibular branch of the facial nerve – Though variable in its course, awareness of its position along the jawline can help avoid serious complications.

• Common peroneal nerve – In the lower limb, damage can lead to foot drop, a complication with major functional consequences.

A/Prof Dicker also highlights commonly overlooked issues such as forehead numbness from small sensory nerves, why tumescent anaesthesia can improve safety in thin-skinned patients, and the importance of patient communication before surgery to manage expectations and reduce distress.

This episode is packed with practical pearls for clinicians working in skin cancer surgery, reminding us that while excision margins and pathology are essential, so too is thoughtful consideration of what lies beneath.

Listen to the podcast

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Life by a Thousand Cuts 

This podcast series is designed to help you enhance your clinical decision-making, procedural skills, and confidence in skin cancer management. Focus on real-world cases, surgical techniques and tips, journal article reviews, diagnostic and management insights, and guest interviews with GPs and specialists.

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About A/Prof Tony Dicker

Associate Professor (Skin Cancer) & Course Coordinator MMed (Skin Cancer), The University of Queensland

Tony Dicker has practised full-time Skin Cancer Medicine in Melbourne since 2004, and previously practised in Brisbane. He obtained his PhD from The University of Queensland in molecular biology of skin cancer with Professor Ian Frazer's group at Princess Alexandra Hospital. He then spent three years as a dermatology registrar at the Royal Brisbane and Princess Alexandra Hospitals.

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