# Innovations in Cutaneous Oncology and Dermatologic Surgery: From Margin Control to Integrated Precision Oncology

## TL;DR

This review discusses how skin cancer treatment has evolved to include surgery combined with other therapies, emphasizing personalized care and multidisciplinary approaches.

## Contribution

The paper highlights the integration of dermatologic surgery with systemic and locoregional therapies in modern precision oncology for skin cancer.

## Key findings

- Surgical excision remains central for curative treatment but is increasingly combined with systemic and locoregional therapies.
- Mohs micrographic surgery and other margin-controlled techniques are critical for function-preserving treatment.
- Targeted therapies and immunotherapy are being integrated with surgery to improve outcomes in high-risk and advanced skin cancers.

## Abstract

Skin cancer treatment has evolved beyond surgery alone. While surgical excision remains the cornerstone of cure for most tumours, advances in targeted therapy, immunotherapy, and locoregional treatments have transformed care for complex and advanced cases. Dermatologic surgery is now integrated within multidisciplinary precision oncology, where treatment sequencing combines surgery with systemic and radiotherapeutic approaches to optimize outcomes and preserve function. This review summarizes recent innovations in cutaneous oncology and explains how modern dermatologic surgeons play a central role in coordinating personalized, multimodal cancer care.

Cutaneous oncology is undergoing a major transformation driven by advances in tumour biology, immunotherapy, targeted agents, and locoregional technologies. Although surgery remains the cornerstone of curative treatment for most skin cancers, an increasing proportion of patients present with high-risk, locally advanced, recurrent, or biologically aggressive disease that challenges a surgery-only paradigm. In this evolving landscape, dermatologic surgery has transitioned from a standalone intervention to a central component of integrated precision oncology. This narrative review provides a clinically oriented synthesis of recent innovations in cutaneous oncology and dermatologic surgery, with a focus on risk-adapted surgical decision-making and multidisciplinary treatment sequencing. We examine the evolving role of margin-controlled and function-preserving techniques, particularly Mohs micrographic surgery, and define clinical scenarios in which standard excision, Mohs surgery, radiotherapy, systemic therapy, or combined approaches are preferred. Quantitative outcome data from pivotal trials are incorporated where available, including local control, recurrence risk, response rates, and survival outcomes. Across major cutaneous malignancies—basal cell carcinoma, cutaneous squamous cell carcinoma, melanoma, and selected rare tumours—we discuss how targeted therapies, immune checkpoint inhibitors, radiotherapy, and locoregional treatments are increasingly integrated with surgery in neoadjuvant, adjuvant, consolidative, and salvage settings. Particular attention is given to treatment-related toxicities, patient selection, and the implications of systemic therapy on surgical timing, reconstruction, and morbidity. High-risk populations, including immunosuppressed patients, are specifically addressed. By outlining adaptive therapeutic algorithms and emphasizing multidisciplinary collaboration, this review highlights the expanding role of the dermatologic surgeon in modern oncology. Surgery remains indispensable for local control and cure; however, its greatest impact now lies in strategic integration with systemic and locoregional therapies to optimise oncologic outcomes, preserve function, and deliver personalised, patient-centred care.