Cary Skin Center

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Information & Instructions for Our Surgical Patients

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Your doctor has referred you to our Skin Cancer Center because the type of skin cancer you have requires a specialized surgical technique (Mohs Micrographic Surgery) to ensure the highest possible cure rate. Mohs surgery uses a sophisticated microscopic method to examine and locate cancerous tissues in the skin. This mapping system allows our doctors to determine if any skin cancer remains and where further surgery is necessary.

Please be sure you can identify the site(s) for surgery BEFORE your appointment date.
We ask your assistance because the biopsy site at times will heal making it difficult for us to locate. Even though the biopsy site may heal, the skin cancer in most cases is still present beneath the surface of the skin. You can help identify the location of your biopsy by taking a close-up photograph and a distant location photograph for reference. This photograph can be a traditional print or a digital image. some referring physicians may obtain photographs in their office and provide you with a copy or you can arrange for them to forward a copy to out office prior to your appointment date via email at photo@caryskincenter.com.

The purpose of this section is to outline expectations for the day of surgery and the post-operative period. Please review this entire section of our web page before your surgery. Many of your questions can be answered by the information presented. Should you require additional information, our staff members will be happy to speak with you.

> Consultation
> Surgery
> How Large Will The Surgical Wound Be After The Skin Cancer Is Removed?
> How Will The Surgical Wound Be Repaired After The Skin Cancer Is Removed?
> Management Of Surgical Wounds
> What To Expect After Surgery
> Follow-Up Visits After Surgery
> Surgery Check List
> Mohs Micrographic Surgery Consent Form

Consultation
Our goal is to provide you with the highest quality of health care. We will conduct a pre-operative consultation to review your health status, accurately locate and make decisions regarding removal of your skin cancer, and arrange any necessary post-operative care. Our staff will review the medications you take and evaluate problems you may have during or after the surgery. You are encouraged to ask questions concerning your skin cancer and surgery. Under most circumstances, we will be able to conduct the consultation on the same day as your surgery.

We will ask you about the length of time the cancer has been present and any previous treatments to that particular area.  After careful review of the pathology report and all information provided to us by your referring physician, you will be asked to confirm the location of the skin cancer.  If possible, please take a photo of the lesion close to the date of the biopsy while the lesion is still visible. For further instructions on how to take your photo, please see Sending Pre-Surgical Skin Cancer Photos.

Your past medical history is also important, as are any medications you take on a regularly. Please bring a complete list of your medications, dosages, and the number of times you take them daily. You should also bring a list of any medications to which you are allergic.

Surgery
Unless instructed otherwise, please have a light breakfast the morning of your surgery. A good night's rest before your surgery is helpful. Because your surgery will be scheduled early in the morning, we suggest that you make arrangements to stay in the Cary area the night before your appointment if you live a long distance from our office. We are happy to provide you with the telephone numbers of local hotels, some of which offer a discounted medical rate.

Take all medications as usual unless directed otherwise. We recommend that you continue all prescribed blood thinners.  This includes physician prescribed aspirin, Coumadin, Warfarin, and all similar drugs.  Please call our office if you have any questions or concerns about your medication.

Your surgery will be performed in our modern outpatient surgical unit. We recommend that a spouse, relative, or friend accompany you to our office. You will spend most of your time in our waiting room while your tissue samples are being examined under the microscope. Also, we strongly recommend that your companion drive following your surgery.

Shortly after your arrival at our surgery unit, you will be escorted to one of our outpatient surgical suites. At this time we will obtain your signature indicating your informed consent for surgery. It is our policy not to allow friends or family into the surgical suite.

A member of our surgical team will then numb the area of skin around your skin cancer using a very small needle and a local anesthetic. A thin layer of skin involved with the cancer will be removed. Any bleeding will be controlled by cauterizing with an electric needle. The wound will be bandaged and you will be able to return to the waiting room.

While you are waiting, the piece of tissue will be processed in our laboratory where it is cut, dyed, made into slides, and read under a microscope by the doctor. This entire process usually requires about an hour. During this time, you will have an opportunity to visit with friends, family, or read. If microscopic examination of your slides shows evidence of tumor cells in your tissue, we will return you to the surgery suite for further surgery in the areas where the tumor remains.

On average, the complete removal of your skin cancer will require two or three trips to the surgical suite. Some cancers, due to their spread into local tissue, will require more sessions to remove the tumor completely. However, even these larger cases can usually be completed in the same day, and only occasionally will we have to complete the surgery on the following day.

You should come prepared to stay all day because it is likely you will require some type of repair of the surgical wound following removal of the cancer. This is usually performed the afternoon of surgery but occasionally must be delayed a day or so.

How Large Will The Surgical Wound Be After The Skin Cancer Is Removed?
It is important to realize that the tumor, which is visible to you - and to your physician - may only be the "tip of the iceberg." Not all cancer cells are apparent to the naked eye. Skin cancers may form roots or "fingers" of diseased tissue that can extend beyond the boundaries of the visible tumor. For this reason we can not predict the actual size of the tumor nor how large the surgical wound will be until after cancer removal is complete.

How Will The Surgical Wound Be Repaired After The Skin Cancer Is Removed?
Mohs surgeons are extensively trained in surgical reconstruction. This includes basic closures, complicated skin flaps, and skin grafts. Mohs surgeons are also trained dermatologists with extensive knowledge of the skin and its healing properties. We are concerned with both the functional and cosmetic outcome of your surgical repair. Generally, we will perform the reconstructive surgery necessary to repair the wound immediately following removal of your skin cancer; however, occasionally we must delay the repair for a day or so. At the completion of your surgery and repair, we will give you verbal and printed instructions on how to care for your wound.

Management Of Surgical Wounds
After the skin cancer has been removed, a decision will be made about how best to manage the wound created by the surgery. Most of the time, the surgical wound must be repaired by stitching it together or by more complex procedures such as skin grafts or skin flaps. These repairs are usually, but not always, performed on the day of your surgery. Occasionally we must delay the repair until the next day.

Skin Flaps and Skin Grafts
To hasten the time to complete healing and improve the cosmetic outcome, we will often recommend that a skin flap or skin graft be performed to repair your surgical wound. This is usually performed the day of your surgery, but scheduling will sometimes require us to delay the repair of a day or so. We will discuss the options available to you following your surgery.

At the completion of your surgery and repair, we will give you verbal and printed instructions on how to care for your wound.

What To Expect After SurgeryDiscomfort of Pain
Severe pain following Mohs surgery is uncommon, but some discomfort may be noticed. We recommend that you take two extra-strength Tylenol® tablets every four to six hours as necessary. Unless your physician has prescribed aspirin or aspirin containing products, please avoid them as they may cause excessive bleeding after surgery.

Bleeding
Bleeding occasionally occurs following surgery. If this happens, do not become alarmed. Lie down and apply firm, continuous pressure for 20 minutes to the wound where the bleeding is occurring. Do not look at the wound for 20 minutes. If the bleeding continues, apply firm, continuous pressure for an additional 20 minutes as before. This almost always stops any bleeding, but should the bleeding persist, notify our office or go to the nearest doctor's office or emergency room for assistance.

Swelling
Swelling is common following any surgical procedure, especially around the eye. Some degree of swelling can be expected, but this usually resolves within one or two weeks.

Drainage
All surgical wounds will drain during the first week or so following surgery. Good wound care will help minimize this problem.

Infection
Infection after skin cancer surgery is unusual. Many patients receive antibiotics to prevent infection. However, if you notice thick, foul-smelling pus coming out of the wound, call our office immediately. An antibiotic is frequently necessary under these conditions.

Redness
Some degree of redness is expected following your surgery. This will resolve as the wound heals. You may experience redness at the surgical site for up to a year, depending on the circumstances of your surgery. If the redness begins to spread out from the wound, it could be a sign of infection or a possible allergic reaction to the ointment or tape used to dress the wound. Call our office and ask to speak with our nursing staff if you suspect a problem. Prolonged redness after surgery is usually an indication of small blood vessel growth around the wound.

Scarring
Scarring always occurs following any type of skin surgery. One of our goals is to minimize the size of your scar by sparing the unnecessary removal of normal tissue. However, our primary goal is the complete removal of your skin cancer. At times, a second procedure is required after your surgical wound has healed to produce an improved cosmetic outcome. We will discuss this possibility with you if it is necessary.


After The Wound Has Healed
You will likely experience some pulling or tightness in the wound and surrounding skin during the healing period. This is normal and will diminish as the surrounding skin stretches. Itching is also a common symptom during the healing process. This is often relieved by gently massaging the scar with Vaseline or vitamin E oil a few times each day.

Skin cancers can involve the nerves in the skin. Consequently, after the skin cancer is removed, you may experience some numbness, which can last up to a year or so. The feeling generally returns, but occasionally the area will be permanently numb. If the skin cancer involves a nerve than controls movement you may experience a temporary or permanent paralysis in the area of your surgery.

The scar tissue that grows over the wound contains many new blood vessels and, therefore, will cause the scar to have a red color. The redness of the scar frequently fades after about a year.

If, after your surgery, you elect to allow your wound to heal on its own and then find the outcome to be unacceptable, we can revise your scar to achieve an improved appearance.

Follow-Up Visits After Surgery
After your skin cancer surgery is completed, you will need to make routine follow-up visits to monitor your wound healing and look for signs of recurrence of your skin cancer or the presence of new skin cancers. These visits are vitally important in the prevention and early detection of skin cancer. Most of the time your referring physician can complete these routine follow-up visits.

If you had a wound repair procedure after your surgery, we will see you in one to two weeks for removal of stitches. You may then be scheduled for a routine follow-up visit in four to six months. After your follow-up visit, we generally have you return to your local doctor for annual visits.

In the few cases where there are recurrences of skin cancer after Mohs micrographic surgery these recurrences usually are detected within two years after surgery. Therefore, we strongly encourage you to continue your follow-up visits.

If you have had a skin cancer, you are likely to develop another in the years ahead. To minimize your problems with skin cancer, your referring physician should evaluate you if a suspicious lesion appears on your skin. A biopsy will be required to determine if the skin lesion is a cancer.

Surgery Check List

  • Complete the Patient Data Sheet and bring it with you to your consultation visit
  • Completely read our consent form in advance
  • We will ask you to confirm the location of the skin cancer. If possible, please take a photo of the lesion close to the date of the biopsy while the lesion is still visible. For further instructions on how to take your photo, please see Sending Pre-Surgical Skin Cancer Photos.
  • Get a good night's sleep before your surgery
  • Unless instructed otherwise, please have a light breakfast prior to surgery
  • Arrive 20 minutes prior to your scheduled appointment time
  • Take all medications as usual unless directed otherwise. We recommend that you continue all prescribed blood thinners.  This includes physician prescribed aspirin, Coumadin, Warfarin, and all similar drugs.  Please call our office if you have any questions or concerns about your medication.
  • Make sure you have taken your pre-operative antibiotics if necessary before surgery.
  • To further reduce the chances of bleeding complications, avoid all alcohol three days before and three days after your surgery, and stop all oral vitamin E supplements.
  • Stop smoking for a period of two weeks before and two weeks after your surgery to improve wound healing.
  • Be prepared to stay at our office all day.
  • Arrange to have a friend or relative drive you home following this or any surgical procedure.


Mohs Micrographic Surgery Consent Form