Complete Dermatological and Mohs Surgeries

What to expect: On the day of surgery, you will be given local anesthesia only (similar to what was given to you during your initial biopsy). You will remain awake. You will verify the location of the skin cancer prior to the onset of the surgery. Once the area is numb, the tissue containing the skin cancer will be removed, taking a small safety margin. The first layer (“Stage I”) will be processed in our laboratory. The wound will be treated for bleeding, and a bandage will be placed to keep you comfortable while you wait approximately 45 minutes-1 hour (for the processing of the tissue). The surgeon will examine the pathology in the lab, checking all the margins.

If any margin is not clear, a second layer (“Stage 2”) will be taken. The area will be re-anesthetized, and the surgeon will remove more skin only in the area where cancer exists. This process will continue until all the skin cancer is removed. Unfortunately, there is no method to predict how many layers or stages will be taken. Once the margins are cleared, the surgeon will discuss the best ways to close the defect. Most wounds may be closed with stitches. A larger wound may require a skin graft or a flap.

Medications: Please take all your normal medications, including blood thinners, the morning of your surgery. If you are a diabetic, please bring your insulin or medications with you, as well as a snack to avoid having low blood sugar during your day with us.

Antibiotics – If you usually require antibiotics prior to dental work, please let the nurse know when you arrive at your appointment. Medical conditions that sometimes require preoperative antibiotics include artificial heart valves, heart murmurs, artificial joints, and related problems.

What to bring with you on the day of your surgery:

• Bring snacks – Since you could be at the office for an extended time, you may bring snacks and/or lunch with you.
• Bring a sweater – Bring a sweater or jacket that buttons or zips down the front and will not disturb your wound dressing during removal.
• Bring something to do – You will be spending much of the day in our office. There will be 45-60 minute waiting periods between layers/stages, so it is nice to have something to keep you occupied, such as books, magazines, knitting, music, or work.

Planning ahead:

• Other appointments – It is important to realize that no matter how small the skin cancer appears to be, looks can be deceiving. Since your surgery may last the entire day, you should not schedule any other appointments that day.
• Special occasions – Surgery often creates swelling and bruising. Also, the post-op dressing may be rather large and obvious. Keep this in mind as you arrange your social/work schedule. If an important event is already planned.
• Activity limits after surgery – If surgery was performed on your face, we recommend that you keep your activity level to a minimum for 2-3 days (the blood pressure elevation related to exercise can lead to bleeding). If you have stitches in an area that will be under tension or significant movement (neck, back, arms, legs), you will need to avoid heavy lifting (anything over 5 pounds) or exercise for at least 2 weeks and possibly longer. We also advise that you limit out-of-town travel for the first 7 days after surgery. You should also wait at least 7 days before going into a pool or the ocean. If surgery is around your mouth area, you may need to eat soft foods, such as soup, milkshakes, or yogurt, for 48 hours.
• Transportation – Mohs surgery is done under local anesthesia. Most patients are able to drive themselves home after the surgery. However, if you’ve had problems after procedures you’ve had done in the past, it may be advisable to bring a companion with you on the day of your surgery to drive you and make sure you get home safely after your surgery. If your surgery is near the eye, postoperative bandaging can also be interference, and having someone drive you to and from surgery should be considered.

Rescheduling: If you need to reschedule your surgery, please notify the office as soon as possible.