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

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.