Local anaesthesia in skin cancer surgery: What the evidence says

Local anaesthetic choice and dosing are such a routine part of skin cancer surgery that it’s easy to fall into habit. But with ongoing supply pressures, evolving research, and the increasing volume of procedures performed in primary care, many GPs are now asking: how low can we safely go with lignocaine concentrations, and does dilution actually work? In this episode of Life by A Thousand Cuts, A/Prof Tony Dicker breaks down the evidence on lignocaine dosing, including what the newer data tells us about using lower concentrations in day-to-day skin cancer work. This episode covers: Why names like lignocaine, lidocaine, Xylocaine, adrenaline, and epinephrine all trace back to the same core agents. How standard concentrations (1% and 2%, with or without adrenaline) compare with the diluted formulations used in dermatologic surgery. What the January 2025 Dermatologic Surgery double-blind trial found when comparing 0.25% vs 0.5% lignocaine, and why both were equally effective for pain control, patient satisfaction, and top-ups. How these findings relate to tumescent anaesthesia in liposuction, where even more dilute solutions still perform reliably. Practical safety limits, including the importance of avoiding unnecessarily large volumes in primary care and maintaining robust processes if your clinic is diluting local anaesthetic. Real-world considerations around toxicity, duration of effect, and past adverse events that underline why careful dosing still matters. If you perform skin cancer procedures in general practice, this is a crisp, evidence-focused update on a tool you use every day, with some simple takeaways you can apply immediately.   Prefer a visual format? Watch this podcast here. 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. Next steps in your learning journey 🎓  NEW Micro-Course: Introduction to the Dermatoscope Led by A/Prof Tony Dicker, this short course introduces the dermatoscope as the clinician’s key diagnostic tool for skin examination — a practical foundation for those beginning their journey in skin cancer detection. ✅ Learn how to use the dermatoscope and capture clinical images. 🎖️ 9.5 hours CPD  •  Online  •   $195 👉 Learn more & enrol >   🎓 Certificate Courses in Skin Cancer Explore our university-assured, structured pathway to elevate your knowledge in the diagnosis and treatment of skin cancer. ➡️ Explore full program