Please eat normally and take all your regularly prescribed medications. If you have an allergy to lidocaine, epinephrine, or antibiotics, please alert your physician before the scheduled surgery. Patients with prosthetic joints or heart disease, including valve replacements or mitral valve prolapse, should take antibiotics before the surgery to prevent infection from starting on the joint or heart valve.
In addition, please tell your physician if any of these apply to you:
You are taking aspirin, ibuprofen, Coumadin, Plavix, other blood thinners, or herbs that cause bleeding such as ginger, gingko, garlic, ginseng, feverfew or St. John's wort.
You are taking anti-inflammatory, anti-arthritis, anti-pain medicines or certain herbs for inflammation, pain, or arthritis.
You have ever had a reaction to a local anesthetic such as Novocain or Xylocaine.
You have heart trouble, artificial heart valves or a pacemaker.
You are allergic to antibiotics or to bandage tape.
You have artificial joints.
You are instructed to take antibiotics before a dental or surgical procedure.
Aspirin, ibuprofen and Advil make people bleed more easily, and we prefer that patients not take it for two weeks before and two days after surgery. If you are taking an aspirin-containing medicine on your own, please stop two weeks prior to surgery. However, if you are taking aspirin on a doctor's order, ask your doctor if you can temporarily stop it. If your physician allows you to stop it, please do so two weeks prior to surgery and resume two days after surgery.
Aspirin containing medications include: Bufferin, Anacin, Alka-Seltzer, Ascriptin, Excedrin, Bayer, Ecotrin, Empirin, 4-Way Cold Tablets, Arthritis Pain Formula, BC Powder, Cama Arthritis Pain Reliever, Momentum Backache Formula, Vanquish and others.
Do not substitute other anti-inflammatory, anti-arthritis, or anti-pain medications for aspirin (except Tylenol) without checking first with your doctor.
The Surgical procedure:
The surgeon will first mark the lesion to be removed. For cancer, an extra margin of tissue will be marked to ensure complete removal. The amount of skin removed will be larger than what was removed for the biopsy. Additionally, tips will be removed to allow for smoother closure. Typically, this will require the excision to be 3-4 times as long as it is wide.
After the area is marked by the surgeon, an assistant will numb the site, usually with Xylocaine with Epinephrine, unless you have a problem with either. Xylocaine is the anesthetic and Epinephrine constricts blood vessels to decrease bleeding. Epinephrine can sometimes make your heart race or make you feel jittery.
The needle is very fine and you will barely feel it. The anesthetic solution stings briefly while being injected, but there is no pain during surgery. You will be conscious during surgery. Therefore, you will be able to drive yourself home afterward.
The surgeon will remove the marked skin and send it to the lab. Sections will be cut and checked to see that the tumor is completely removed. Bleeding will be stopped with cautery. The skin edges will then be sewn closed. Sutures will be removed in 5 to 21 days, depending on the location (legs take longer to heal than the face).
After Surgery:
Your incision will be dressed by an assistant before you leave the office and you may be given an additional dressing to use after the first day. The incision should remain covered until the sutures are removed. If the dressing is not soiled it is best not to remove it until you return to the office. Please do not use any creams containing Neosporin, Bacitracin or Triple Antibiotic Ointment since these commonly cause allergies. Do not apply hydrogen peroxide, alcohol or soap to the incision.
Aftercare instructions:
When you arrive home after your surgery, take it easy and do not engage in exercise, lifting or bending, as this may cause the sutures to give way or bleeding at the incision. Sit or lie quietly and use a bag of frozen peas over the incision to reduce swelling for the first day. After the first 24 hours you may increase your activities.
You will need to keep the excision site dry for at least 24 hours. You may take a shower the next day.
Most bleeding can be controlled by holding pressure directly over the incision for 20 minutes. If you experience excessive bleeding or significant pain or redness at the surgical site, please call your physician, or if after hours, call the emergency room.
Pain can be controlled with ExtraStrength Tylenol (acetaminophen). Please refrain from taking aspirin, ibuprofen, Motrin, Advil, Alleve, or herbs that cause bleeding.
If you haven't done so before, you should begin taking Vitamin C , 3,000-5,000 mg per day which you can take in divided doses. Vitamin C is important for collagen synthesis which is the chief component of scar tissue. A stronger, thinner scar will result if you take Vitamin C for at least 3-6 months after your surgery.
Is there scarring?
When a cut heals it does so by forming a scar. Every effort is made during surgery to minimize the scar. Often a scar may be barely visible, especially if the skin is wrinkled. However, on the chest, shoulders, back, arms and legs, scars may spread, often become thickened, and may not be cosmetically acceptable. Moderate doses of Vitamin C (3,000-5,000 mg per day) taken during the wound healing process for 3-6 months will result in a stronger, thinner scar in most cases. Please inform your physician if you have a history of forming keloid scars.
Post Operative Complications:
All surgery carries the risk of untoward events which may include:
Unexpected reaction to local anesthetic. These are very rare and can include wheezing, hives or a rash. Please report these to your physician immediately.
Post operative bleeding. As outlined above, pressure for 20 minutes over the incision should stop the bleeding but if not, call your physician.
Post operative infection. Increasing pain, redness or pus at the incision site should prompt a call to your physician.
Poor wound healing and scar formation. With adequate Vitamin C supplementation, above, this should not occur. Please advise your physician if you have a history of poor wound healing.
Numbness in adjacent skin. This is a fairly frequent complication since small nerves may be cut during removal of the tumor. Generally, the nerve will regrow within a period of 6-12 months and the sensation will return. You may also experience tingling or pain while the nerve is regrowing into the area. Homeopathic Hypericum can sometimes relieve these symptoms.
Recurrence of original lesion. This may occur in up to 3% of cases. A second surgery would then be necessary.
Follow Up Evaluations:
You will be advised when to return for your first postoperative check and suture removal. This is usually simple and fairly painless. If you have had a skin cancer surgery, there is not only a small risk of it recurring, but you are at increased risk to develop other skin cancers. (This does not mean that you are at increased risk for internal cancers.)
It is important that you set periodic rechecks usually every three months for the first year and twice a year thereafter. After any visit, you should find out when your next recheck is due. It is best to make the appointment before you leave the office.
You will also want to review the causes of skin cancer such as sun damage and premature aging and make appropriate lifestyle changes to avoid skin cancer recurrence.
What is Mohs Surgery?
Mohs Surgery is a procedure in which the surgeon removes a skin cancer and immediately checks the margins to ensure complete removal. If the microscopic sections reveal residual cancer, the surgeon continues removing layers and checking with the microscope until all the tumor is eradicated during the same visit. The surgeon usually repairs the wound during this visit also unless it is very large or located in a delicate site such as the eyelid, in which case a plastic or ophthalmic surgeon may become involved to close the defect.
Mohs Surgery is indicated for tumors on the eyelids, nose, ears or lips, where it's important to take the least amount of tissue necessary, yet fully remove the tumor. It is also used for specific types of skin cancers and if a cancer has recurred after a surgical procedure.
