Preparing for Mohs Surgery
How do I prepare for the day of surgery?The best preparation for Mohs surgery is a good night's rest followed by breakfast. In most cases, the surgery will be completed on an outpatient basis. If you wish to have an anti-anxiety medication, it will be given to you before the surgery begins. Because you can expect to be here for most of the day, it is wise to bring along a book or magazine. Also, because the day may prove to be quite tiring, it is advisable to have someone accompany you the day of surgery to provide companionship and a ride home. If you are given an anti-anxiety medication, we require that someone else drive you home.
You may be asked to have a preoperative visit to discuss your surgery. At this visit, the technique will be discussed in detail, you will meet the team performing the surgery, a biopsy may be performed (if it has not already been done) and necessary paperwork will be finished (consents, insurance forms, etc.).
If you are coming from a great distance and/or are being referred by a physician familiar with the technique, you may be referred directly for Mohs surgery without a preoperative visit. If you are new to our clinic then a map and travel instructions are included with this booklet, in addition to a questionnaire concerning allergies, medications, and medical history. Please fill this out and bring it with you on the day of surgery.
We request that you stop taking any aspirin or ibuprofen compounds (like Anacin, Bufferin, Advil or Motrin) at least one week before your surgery. This is because it may interfere with the normal blood clotting mechanism, making you bleed more than normal during surgery. If your doctor recommends aspirin please verify with your doctor before discontinuing aspirin. Alcohol, Vitamin E, ginko biloba and garlic pills also increase your bleeding risk, so please discontinue taking these at least one week prior to surgery.
Most insurance carriers cover the cost of Mohs surgery and reconstruction. Please be prepared to give insurance information to our billing office and bring any forms with you that may need processing. We can counsel you concerning your insurance coverage at the time of surgery. If your insurance plan requires pre-approval or an HMO referral, please help us to make sure this is in place prior to your surgery.
What happens the day of surgery?Your appointment has purposely been scheduled early in the day. Upon your arrival you should check in at the registration window in the Dermatology Ambulatory Surgery Center on the fifth floor of the Center for Health & Healing. When the surgical suite becomes available, our nurse will escort you to that area of clinic. If you have not had a consultation visit, we will go through the procedure with you, examine the questionnaire you have filled out, and answer any questions you have. A surgeon will also be available to answer questions.
After preliminary preparation of the skin, you will be placed on the surgical table and the area around your skin cancer will be anesthetized (numbed) using a local anesthetic (a shot). This may be uncomfortable, but usually this is the only pain you will feel during the procedure. Once the area is numbed, a disco shaped piece of tissue will be removed and the bleeding controlled. The tissue will be carefully handled by the surgeon, diagrammed, and sent to the technician to be processed into microscopic slides. A pressure dressing will be over your surgical wound, and you will be free to wait in the waiting area. On the average, it takes an hour for the slides to be prepared and studied. During this time you may rest, read your book or magazine, or take a walk around the building. There is a restaurant and coffee bar located on the first floor.
Most Mohs surgery cases are completed in two or three stages. You will be re-anesthetized for each stage needed. Each stage involves the removal and microscopic examination of your skin for cancer. Therefore, the majority of cases are finished in one day. Once we are sure that we have totally removed your skin cancer, we will discuss our recommendations with you for dealing with your surgical wound. Often, the wound can be closed the same day.
What can I expect after the surgery is complete?
BleedingA small number of patients will experience some post-operative bleeding. It can usually be controlled by the use of pressure. You should take a gauze pad and apply constant pressure over the bleeding point for 20 minutes. Do not lift up or relieve the pressure at all during that period of time. If bleeding persists after continued pressure for 20 minutes, repeat the pressure for another 20 minutes. If this fails, a physician can be reached 24 hours a day by calling (503) 494-9000, and asking for the dermatologist on call. If necessary, visit a local emergency room for assistance. Your wound care instructions will also list phone numbers if you have questions.
ComplicationsThere are some minor complications which may occur after Mohs surgery. A small red area may develop around your wound. This is normal and does not necessarily indicate infection. However, if the redness does not subside in two days or the wound begins to drain pus, you should notify us immediately.
Itching and redness around the wound, especially in areas where adhesive tape has been applied, are not uncommon. If this occurs, ask your pharmacist for a non-allergenic tape and let us know about this complication on your return visit.
Swelling and bruising are very common following Mohs surgery, particularly when performed around the eyes and mouth. This usually subsides within four to five days after surgery and may be decreased by the use of an ice pack in the first 24 hours.
NumbnessAt times, the area surrounding your operative site will be numb to the touch. This area of numbness may persist for several months or longer. In some instances it may be permanent. If this occurs, please discuss it with your physician at your follow-up visit.
Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. The scar can be minimized by the proper care of your wound. We will discuss wound care in detail with you and give you wound care information, which will explicitly outline how to take care of whatever type of wound you have.
Will I develop more skin cancers?After having skin cancer, statistics say that you have a higher chance of developing a second. The damage your skin has already received from the sun cannot be reversed. However, there are precautions that can be taken to prevent further skin cancers. They involve good common sense. You should use a sunscreen; applying it at least 10 minutes before exposure to light. Higher SPF numbers are more protective. We recommend that you use a SFP of 30 or higher sunscreen. Regardless of manufacturers' claims, we recommend that you reapply sunscreen after swimming. A wide-brimmed hat, long-sleeved shirt and other protective clothing are also appropriate. Avoidance of excessive sunshine is recommended.
You should have your skin checked very closely by a physician at six-month intervals. Our policy is to follow the majority of our patients until the wound is healed. Once the wound is healded, patients can continue with their referring physician. If you have not yet established care with a dermatologist, your surgeon can give you a referral. We recommend six-month follow-up visits for two years, then yearly. Of course, any areas of skin that change, fail to heal, or just concern you should be brought to the attention of your referring dermatologist immediately. He or she can adequately treat most skin cancers when they are detected early.