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Microsoft word - mohs surgery preparation.docxMohs Surgery Preparation & Care Guide
Mohs surgery is a procedure that may take the entire day. Although patients normally spend
approximately 3-5 hours in our office, please do not schedule any other appointments for your
surgery day. You should plan on being here for the entire day and plan accordingly.
Please review the following checklist prior to your scheduled surgery appointment on
____________________ in our __________________________ office.
• We encourage you to eat a regular meal(s) on the day of your scheduled surgery. • Take all of your medications. If you are taking any medications which slow coagulation (“blood-thinners), do not discontinue these medications unless specifically instructed by
the doctor who prescribed them. Please do not stop them on your own. If you are unsure
of what medications you should stop taking, please call our office at (215) 345-6647 for
You have been instructed to discontinue the following medications one (1)
week prior to your scheduled surgery:
• Please discontinue use of Vitamin E and any non-essential “natural” supplements or herbal medications one (1) week prior to surgery. Examples include but are not limited to: Echinacea, red-yeast rice, fish oil, omega-3 supplements, glucosamine, chondroitin and ginko biloba. Many of these supplements and medications are associated with bleeding. • If you take antibiotics prior to surgery for any condition such as heart related issues or artificial joints, please call your doctor regarding the necessity of taking an antibiotic prior to Mohs surgery. You have been instructed to take the following antibiotics one (1) hour prior
to your scheduled Mohs surgery:
You do not require antibiotics prior to surgery. Amoxicillin – 4 pills 1 hour prior to surgery Clindamycin – 2 pills 1 hour prior to surgery Other: ____________________________________ Mohs Surgery Preparation & Care Guide • Please refrain from consuming alcoholic beverages several days before and after the procedure. Alcohol dilates the blood vessels and may increase bleeding and bruising tendencies. • There is a significant amount of time spent waiting for laboratory results between the Mohs steps. Please bring sufficient reading or work. It is often helpful to bring a companion. Due to limited room in our waiting room, we ask you do not bring more than one person to join you. And due to the lengthy nature of the procedure, please do not bring children with you on the day of surgery. We have Wi-Fi internet access, so please feel free to bring a laptop, iPad or iPod with you to pass the time. We have coffee, tea and snacks available in our Mohs waiting area, but we encourage you to also bring a lunch. • You may wish to review your personal and work schedules for the week or two following your surgery. The wound will be repaired with sutures once the skin cancer has been removed, and you will need to have these sutures removed approximately one week after surgery. • You may wish to pre-purchase the items necessary for wound care. These items are listed in the wound care section of these instructions. • It is crucial that we are able to identify the site of your skin cancer. Often following a biopsy, the site heals so well that the location of the skin cancer is no longer obvious. The biopsy report tells us the diagnosis and general location. If you cannot see or recall the site of the skin cancer, it is important to have your referring physician document the site with a photograph or mark the area on your skin with a semi-permanent marker. If we cannot identify the location, we will be unable to do the surgery.
What does the procedure involve?
Mohs surgery is a minor surgical procedure performed on an outpatient basis in our office. The
Mohs procedure provides a road map allowing us to trace the extent of the cancerous growth.
Since the laboratory processing is time consuming, please be prepared to spend the entire day. In
many cases, less time is required but there is no way to predict the length of your surgery. The
procedure is performed under local anesthesia. Even though you may physically be able to drive
yourself home, we advise you to have a friend or family member drive you to and from surgery.
You may be tired following surgery and will have some swelling. Your bandage may also
obstruct your vision. We do not recommend that you drive yourself home following surgery.
The surgery is performed in steps or stages. Each stage involves about 5 to 15 minutes of surgery
to remove the cancerous tissue plus about 45 minutes to an hour (or more) to check if any cancer
remains. The number of steps or stages required depends on the size and depth of the cancer.
The procedure is not finished until the last laboratory examination shows no remaining
Mohs Surgery Preparation & Care Guide • Once the area is located, marked and cleaned, a local anesthetic (usually Lidocaine or Xylocaine) will be injected into the surgical area. This is the only part of the procedure that will cause discomfort. There will be the sensation of stinging or burning. We inject very slowly to minimize the discomfort as much as possible. • Once the area is numb, a small layer of tissue will be removed with a scalpel. Unless the cancer is quite small, or the original biopsy was curative, more surgery is almost always required. Remember, it is always better to initially remove too little and perform a second stage than to remove more normal tissue than necessary. • The small amount of bleeding will be stopped with a machine that coagulates the blood vessels. A dressing will be applied, and you will return to the waiting room. You are allowed to eat, drink and simply relax while the tissue is being processed. • The tissue will be brought to the laboratory, where it will be examined for the presence of skin cancer. The tissue is processed, and microscopic slides are prepared and examined. • If microscopic examination reveals remaining tumor, a map is drawn indicating the • You are then brought back to the operating suite, and additional anesthetic is injected to reinforce the first injection. In most cases, the initial anesthetic has not worn off, and you will feel little to no discomfort. • The second stage involves the removal of another layer of tissue but only where the map indicates residual cancer. The healthy tissue is left intact; only the diseased tissue is excised. • The tissue is brought to the laboratory and the process is repeated until all evident cancer The average tumor requires two to four stages for removal. Do not be discouraged if your cancer
is not removed in one step. We are tracing the extent of the tumor very carefully and trying hard
to minimize the removal of normal tissue. This must be done in small layers.
Repair options following Mohs:
When your Mohs surgery is complete, there will be a defect or open wound in the area that the
skin cancer occupied. In the vast majority of cases, the wound will be repaired by Dr. Willard
using one of a variety of reconstructive plastic surgical methods. This involves the placement of
both buried and superficial sutures to produce the least visible scar and to accelerate the healing
process. Wounds are typically repaired in one of three ways: direct side-to-side closures (linear
closure); surgical rearrangement of excess skin in nearby locations (a flap) that is moved into the
Mohs Surgery Preparation & Care Guide
defect; or a skin graft usually obtained from around the ear or upper chest. These methods
usually produce excellent cosmetic results.
There is always the option to consider revision of a healed wound if the cosmetic result is
What is the goal of Mohs?
The main goal of Mohs is to remove skin cancer as completely as possible and prevent
recurrence. This procedure is regarded as the most precise of all treatments, and the cure rate
How do I care for my wound after surgery?
It is important to care for the wound twice a day to achieve adequate healing. For open wounds,
we tend to discourage scab formation by coating the area with either Vaseline or Aquaphor. Both
should be obtained as fresh, clean tubes – not jars. Scabs are similar to pouring cement in the
wound. They prevent the wound from healing easily from the bottom and sides, producing more
indentation and slower healing. Sutured wounds need cleaning and ointment to allow the sutured
edges to stay in contact with each other. If the skin edges are pushed apart by crusts or scabs, the
suture line and scar will be wider and more visible.
All patients should purchase the following wound care items:
• Non-sterile Q-tips • A fresh tube (not a jar) of Vaseline or Aquaphor ointment (Do not purchase Neosporin or triple-antibiotic ointment. Many patients develop an allergy to this medication if used frequently) • Non-stick gauze such as Telfa • Non-allergic tape such as Micropore. We do not recommend cloth or plastic tape as they If your wound is left open, you should use saline (a specific concentration of saltwater) as a
cleaning agent. Saline is the most gentle and can be found over the counter in most pharmacies
as one of the following: contact lens solution (not chemical lens solution); eye wash (not boric
acid) and in some nasal sprays (saline only).
Mohs Surgery Preparation & Care Guide Please follow the following steps when cleaning your surgical area; • Clean the wound gently with a cotton swab (Q-tip) dipped in the appropriate cleaning • Use a second, dry Q-tip rolled over the wound to dry it. • Use a third Q-tip to apply Vaseline or Aquaphor ointment to the wound. • Cover with an appropriately cut and sized piece of non-stick Telfa. • You may shower 24 hours post-op. The bandage should be removed prior to showering. There are a few things to avoid during the healing process: • Do not physically disturb the healing wound during the first 4 weeks following surgery. Do not massage the area, apply Vitamin E or “test” the area by pulling or stretching. This will widen the scar and prevent the best cosmetic outcome. • Do not apply make-up during the 3 weeks following surgery. The make-up will “cake” in the wound and affect healing. If coverage is desired, continue to use a dressing. • Do not apply sunscreen to the wound for 3 to 4 weeks following surgery. Sunscreen may
What can I expect when I go home?
Localized discomfort is normal and usually mild enough to be managed with Tylenol. If more
significant pain is anticipated, we can provide a prescription for a stronger pain reliever.
A pressure bandage is applied to the wound in the office, and is to be left on for 24 hours to
minimize swelling and bleeding. Although some minimal bleeding is typical, persistent or heavy
bleeding after surgery is infrequent. Moderate bruising and swelling is common, and may take up
to two weeks to resolve.
Are there any restrictions?
Exercise, lifting and bending should be minimized for at least one week post-surgery, usually
until the sutures are removed, to prevent unnecessary bleeding or swelling.
What happens if my wound starts bleeding?
If bleeding occurs, remove the bandage and lie down. With gauze and a clean, dry wash cloth
and apply firm, constant pressure directly to the wound for 20 minutes. Do not just pat the
Mohs Surgery Preparation & Care Guide wound for a few minutes – you need to apply constant pressure for 20 minutes without looking.
If the bleeding persists, call the office at (215) 345-6647 or, if it after office hours, call Dr.
Willard’s cell phone at (215) 629-9025.
What if my wound becomes infected?
Wound infection is very rare, but is treatable with oral antibiotics. Please call the office if the
wound site is extremely swollen, red, very warm to the touch , if you are running a fever or
experiencing moderate to severe discomfort.
Will I have a scar?
It is important to remember that every surgical procedure, regardless of the surgeon who
performs it or the location on the body, produces some scarring. Although every attempt will
be made to minimize and hide the scar, this is not always possible. The extent of scarring and the
appearance depends on a number of factors, including:
• The method of healing • The size and depth of the cancer • The location of the cancer and how well you heal
The skin may appear red and firm or lumpy initially, but this will normally resolve within 4-8
weeks. Occasionally, some of the deeper stitches that normally dissolve on their own work their
way to the surface; these are called “spitting sutures.” These will dissolve with warm compresses
or can be removed in the office.
We look forward to making your office visit as pleasant and comfortable as possible. Our
mission is to provide the most effective treatment in terms of cure and cosmetic outcome. We
will attempt to attend to both your emotional and medical needs. Please remember, this
information only provides a general guide to skin cancer and Mohs surgery.
Our staff is here to help, so please feel free to contact the office with any questions or concerns.
Mohs Surgery Preparation & Care Guide
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