Surgery Day
Before Surgery
Be well rested and eat a good breakfast. Take your usual medications, unless directed otherwise. We request that you do not take any aspirin or aspirin containing products, such as Anacin, Bufferin, Ibuprofen (Motrin, Advil, etc.) for ten days prior to the surgery UNLESS DIRECTED BY YOUR PHYSICIAN. These medications may “thin” your blood and cause more bleeding. You may substitute acetaminophen (Tylenol) if required. Do not drink any alcoholic beverages for 24 hours before surgery.
Shampoo your hair the night before surgery, as your wound and initial dressing may have to remain dry for 48 hours thereafter. The length of the procedure varies depending on the size and location of the skin cancer and the type of reconstruction to be done. You should plan on spending most of the day in our office. We ask that you limit the number of people accompanying you to one because of the limited space in our waiting room. There is plenty of time spent waiting for the lab work, so bring a book or handiwork to keep busy, and lunch or a snack.
The Day of Surgery
Appointments for surgery are scheduled throughout the day. It is a good idea to wear loose fitting clothing and avoid “pullover” clothing. Also, if the operative site is on the face, please do not wear make-up. We will obtain your written consent for the procedure, photographs will be taken, and your blood pressure will be recorded. If you have any additional questions, please feel free to ask them at this time.
The area surrounding the skin cancer will be cleansed with an anti-bacterial soap. The doctor will then anesthetize (numb) the area of skin containing the cancer by a small local injection. This injection will probably be similar to the one you received for your biopsy. We will be as gentle as we can when administering this. It usually takes 15 minutes to anesthetize the involved area and remove the tissue. After the tissue has been removed, it will be processed in our office laboratory. Depending on the amount of tissue removed, processing usually takes an additional 45 minutes. Your wound will be bandaged, and you will move to the waiting room while the tissue is processed and examined by your physician. If the microscopic examination of the removed tissue reveals the presence of an additional tumor, we will go back and remove more tissue. The Mohs technique allows us to precisely map out where the roots of the cancer remain. Most skin cancers are removed in 1-3 surgical stages.
After the skin cancer has been completely removed, a decision is made on the best method for treating the wound created by the surgery. These methods include letting the would heal by itself, closing the wound in a side to side fashion with stitches, closing the wound with a skin graft or a flap. In most cases, the best method is determined on an individual basis after the final defect is known. Sometimes other surgical specialists may be utilized for their unique skills if the tumor turns out to be larger than initially anticipated. We individualize your treatment to achieve the best results.
When the reconstruction is completed by the other surgical specialists, that reconstruction may take place on the same day or on a subsequent day. There is no harm in delaying the reconstruction for several days. If the reconstruction is to be extensive, that portion of the operation may require sedation or hospitalization. This is the exception rather than the rule.
After Surgery
Your surgical wound will likely require care during the weeks following surgery. Detailed written instructions will be provided. You should plan on wearing a bandage and avoiding strenuous physical activity for a week. Most of our patients report minimal pain which responds readily to Tylenol. You may experience a sensation of tightness across the area of surgery. Skin cancers frequently involve nerves and months pass before your skin sensation returns to normal. In rare instances, the numbness may be permanent. You may also experience itching after your wound has healed. Complete healing of the surgical scar takes place over 12-18 months. Especially during the first few months, the site may feel “thick”, swollen, or lumpy, and there may be some redness. Gentle massage of the area (starting about 1 month after the surgery) will speed the healing process.
An indefinite follow-up period of observation is necessary after the wound has healed. You will be asked to return in six weeks, six months and one year following the procedure. Studies have also shown that once you develop a skin cancer, there is a strong possibility of developing other skin cancers in the future. Should you notice any suspicious areas, it is best to check with your physician for a complete evaluation. You will be reminded to return to your dermatologist on a frequent basis for continued surveillance of your skin.
