Background: Patients undergoing surgery for basal and early squamous cell carcinomas are rarely offered psychological support as their malignancies have a low mortality. Nonetheless, 80 % of non-melanoma skin cancers occur in the head and neck, rendering both the malignancy and subsequent surgical scar clearly visible. This study was designed to quantify the social and emotional impact of facial skin malignancies pre- and postoperatively and to identify vulnerable groups who may benefit from increased support irrespective of tumour severity. Methods: Fifty-three patients with facial skin malignancies were prospectively evaluated before and 3 months after surgery using the Skin Cancer Index (SCI); a 15-item, validated, disease-specific quality-of-life (QOL) assessment tool with emotion, social and appearance subscales. Higher scores reflect improvements in QOL. Results: Surgical excision of the malignancy led to a significant increase in SCI (p < 0.001). Increasing age was associated with greater post-surgery QOL, controlling for baseline scores (p = 0.037). Other clinical/demographical variables were not significantly associated with SCI scores in most models; however, patients with squamous cell carcinomas reported greater improvements that those with basal cell carcinomas. Women had lower baseline scores but showed greater improvement in the emotional and appearance subscales. Men showed greater improvement in the social subscale. Preoperative SCI scores were generally better predictors of postoperative scores than demographic or clinical factors. Conclusion: Lower preoperative SCI scores confirm the presence of anxiety among patients with cutaneous facial malignancies. Surgical excision improves social, emotional and cosmetic well-being, particularly in patients with squamous cell carcinomas. Female and younger patients appear most vulnerable to QOL anxieties preoperatively. Level of Evidence: Level III, prognostic study.