Mohs Micrographic Surgery
The following instructions and checklist are provided in order to help you be prepared for your surgery. Please bring your insurance cards, medication list, and any other information requested in the preoperative instructions below.
Please do not take any aspirin, aspirin containing products or Ibuprofen (Advil, Motrin) 7 days prior to your surgery (these products increase the bleeding during the procedure). If you have been placed on these products on the recommendation of your doctor please contact him/her prior to you discontinuing the medicine for their approval. VERY IMPORTANT: if you take aspirin because you have had a stroke or heart attack, please continue your aspirin.
If you are on Coumadin or Plavix please check with your doctor to see if you can stop it or lower the dose a few days before the surgery. It is not absolutely necessary to stop this medications.
Certain herbal medications can increase your risk for bleeding during surgery. Please stop taking garlic, ginkgo, ginseng and ginger at least 72 hours prior to your surgery.
If you need pain medicine you may take Tylenol.
If you smoke your surgery site will heal better if you discontinue smoking for 48 hours prior to the procedure and during the recovery period.
No Alcohol 24 hours prior to the surgery and 24 hours after...sorry, it makes you bleed easier.
You do not have to fast prior to surgery. Please enjoy a normal breakfast or lunch before coming to the office. Since the procedure is likely to take a number of hours it is a good idea to bring a snack.
Please cancel all activities for the day of surgery and possibly longer. You will receive postoperative instructions about how to care for your surgery site before you leave our office.
Please check your medications and bring a list of all medications you are taking unless you have written the list of your medications on the medical history form.
Please arrive 15 minutes prior to your scheduled surgery time.
Notify your physician if you have a pacemaker or intracardiac defibrillator.
The duration of your visit will depend on the extent and complexity of your skin cancer. For early morning appointments, we ask that you plan to be at our office until approximately lunchtime. For late morning appointments, we ask that you plan to be in our office through the early afternoon. However, this does not mean that you will be in surgery the entire time. After surgical removal, we process the tissue in the lab, which takes at least one hour. At that time the tissue will be analyzed, and if the margins show no remaining cancer, the necessary means to repair the area will take place. However, if the tissue shows roots of cancer extending through the margin, a second layer will be taken to be analyzed. This process takes place repeatedly until all the margins are cleared. This method is performed to assure that all the cancer cells are removed, so there is less chance of any recurrence
Please give 48 hours notice for change in time of surgery.
Once the surgical site is identified, the area surrounding the skin cancer will be anesthetized (numbed) by a small local injection similar to the one you received for your biopsy. After the skin cancer has been completely removed by the Mohs technique, a decision is made on the best method for treating the wound created by the surgery. These methods include letting the wound heal by itself, closing the wound in a side-to-side fashion with stitches, closing the wound with a skin graft or flap, or smoothing down the edges of the area without any stitches. In most cases, the best method is determined on an individual basis after the cancer is cleared and the final defect is known.
Your surgical wound will require simple at home care during the weeks following the surgery. Printed instructions will be available in the office after your surgery is complete.
You should plan on wearing a bandage for 10-14 days.
Plan to avoid strenuous physical activity for at least 48 hours after surgery. In most cases, you should not plan athletic or exercise activities for 2-3 weeks after surgery in order to let your surgical site begin to heal. Refraining from activities for 2-3 weeks helps allow proper healing, and helps allow your healthy return to activities as soon as possible.
Skin cancers frequently involve small superficial nerves, and months may pass before your skin sensation returns to normal. A numb or tingling sensation may be expected over the area. This is common and usually expected, but typically will return to normal with time. In very rare instances, the numbness may be permanent.
Complete healing of the scar takes place over 3-12 months
During the first few months the scar may feel "thick, swollen or lumpy", and there may be some redness. Gentle massage of the area (starting about one month after your surgery and excluding grafts) will speed the healing process.
The defect created by the removal of the skin cancer may be larger than anticipated. There is no way to predict prior to surgery the exact size of the final defect.
There will be a scar at the site of removal. Unfortunately, there is no way to remove a skin cancer without some degree of scarring. However, having your scar look as small and as good as possible after cancer removal is important to us as well. We will make every effort to obtain optimal cosmetic results, but our primary goal is to remove the entire tumor. Again, Mohs surgery will leave you with the smallest wound, thus creating the best opportunity for optimal cosmetic results.
In some cases there may be poor wound healing. At times, despite our best efforts, for various reasons (such as bleeding, poor physical condition, smoking, diabetes, or other diseases), healing is slow or the wound may re-open. Flaps and grafts used to repair the defect may at times fail also. Although these instances are not common, they are to be expected with the instances listed above. Under these circumstances, the wound will usually be left to heal on its own, and in some cases after healing, certain procedures may be done to improve the cosmetic appearance of the area.
There is a small chance that your tumor may re-grow after surgery. Previously treated tumors and large, longstanding tumors have the greatest chance of recurrence.
If you have any questions, please feel free to call our office for assistance.