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What happens the day of surgery?
In order to expedite treatment of skin cancers, Skin Cancer Specialists offer several different types of appointments. You may be required to return the day following Mohs surgery, or you may be coordinated with one of our Plastic Surgeon colleagues for wound repair. We will recommend the best option for your specific circumstances since waiting lists often vary significantly between the appointment types.
Appointments for surgery are scheduled early in the day. This allows us to complete several surgical stages throughout the day (if necessary) and relieves you of having to make another trip to the office the next day. Our staff will escort you into a surgical suite where Dr. Griego or Dr. Skinner will perform a detailed pre-operative consultation including: a review your medical history and pathology reports; a comprehensive examination of your skin; and customized answers to any questions you may have regarding your diagnosis and the procedure.When you are ready, your doctor will use a local anesthetic to numb the area around the cancer. Once it is numb and cleansed, the procedure will be initiated by the removal of the visible portion of the tumor by either curettage or excision. When the visible portion of the tumor is debulked, a thin layer of tissue will be surgically excised completely around and underneath the skin cancer. This layer of tissue is generally 1-2 mm in thickness. The excised tissue then will be carefully inked, diagramed, and processed in the laboratory which is contained within the office. The tissue is then frozen, cut into microscopically thin sect ions, and then processed through a staining machine to make visible all of the cells contained within the specimen.
Once the microscopic slide is prepared, your doctor will personally examine the entire undersurface and outside edges of the tissue that surrounded the skin cancer. Any tumor that is seen remaining during the microscopic examination will be carefully marked on the map which precisely locates that area relative to the patient's skin. An additional thin layer of tissue is then excised from the exact area that demonstrated the involvement with cancer. This sequence will be repeated as often as necessary to completely remove the cancer.We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for microscopic slides to be processed and examined. Magazines and beverages will be available in the waiting room area. Most patients find it helpful to bring along a friend or family member to help them pass the time. Although this is STRONGLY encouraged, we ask that you limit the number of companions to ONE because of the limited capacity of our waiting area. If your visit extends through the lunch hour, your companion may wish to visit one of the neighboring restaurants to bring you a snack or lunch. Because of possible complications with bleeding, all patients are asked not to leave the waiting area of our office. The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be in the office the entire day and that you make no other commitments.
Will I be hospitalized?
No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day. Hospital facilities are available if necessary.
Will the surgery leave a scar?
Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose (1) to leave the wound to heal itself, (2) to repair the wound with stitches, or (3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result.
Why would a wound be allowed to heal itself?
In some instances allowing a wound to heal without surgical reconstruction is the best option. In some anatomic locations natural wound healing results in a better cosmetic outcome than even the best surgeon's reconstruction. In other instances the tissue-sparing benefits of Mohs surgery allow removal of a cancer with a resultant wound so superficial that there is literally nothing to stitch up. If the wound is allowed to heal by natural processes, it usually heals in 3 to 8 weeks, depending upon the size and depth of the wound. During this period of time, daily bandage changes and wound care provided by the patient expedite the process and prevent infection.
The most modern wound healing methods will be explained by the medical staff and provided in written detail to clarify the patient's responsibilities.
Will I have pain after the surgery?
Most patients do not complain of pain. If there is any discomfort, Tylenol is all that is usually necessary for relief. Avoid taking aspirin-containing medications as they may cause bleeding.
If you know that you typically require a narcotic for pain relief after minor surgery, please do not hesitate to request this on the day of treatment.