Mohs Surgical Patients
How to Prepare for Mohs Surgery and Reconstruction
Eating Before Surgery
Patients should eat a normal breakfast prior to arriving for surgery. In the event that surgery requires several stages, patients may pack a lunch or bring snacks to eat during the day. Refrigeration is available upon request. Alcohol may cause increased bleeding. Please avoid alcohol for one day prior to surgery and two days after surgery.
Transportation
You will be permitted to drive after surgery. You may bring someone with you to keep you company while you wait, but it is not required. However, depending on the location of the operative site, your ability to drive may be affected by the surgical bandages. When scheduling your surgical appointment, please ask if a separate driver will be necessary.
What to Bring
- List of current medications and their dosage
- Lunch, snacks, drinks if desired
- Wear clothing that does not have to be pulled over your head
Prescription Medications
Before surgery, it is not necessary to stop medications prescribed or ordered by primary care or other physicians, including blood thinners.
Continue to take all medications as prescribed by your physician. Be sure to take all of your medications on the morning of surgery, and bring any doses that you take during the day with you to our office. Patients should bring a complete list of their medications on the day of the scheduled surgeries.
Over-the-Counter or Supplemental Medications
We do not insist that you stop taking medications that thin the blood such as aspirin, Ibuprofen (e.g., Motrin®, Advil®), Vitamin E or other nutritional/food supplements. While you are not required to stop these medications, please advise our Mohs surgeon if you are still taking these medications. Please refrain from drinking alcoholic beverages three days prior to the surgery and three days after the surgery since alcohol increases the risk of bleeding.
Antibiotics
Antibiotics are usually not prescribed prior to Mohs surgery. However, if your primary care or other doctor has recommended taking antibiotics before procedures, we suggest taking the antibiotics 30 to 60 minutes prior to the surgery. This applies especially for patients that have had:
- Joint replacement surgery within the past year
- Artificial heart or heart valves
- History of endocarditis/infected heart valves
- Severe dysfunction of a heart valve
Patients that qualify for any of these medical situations should contact their primary care physician (or other specialist who recommended antibiotics before surgery) two to three days before the Mohs surgery appointment so an appropriate antibiotic can be prescribed.
After Surgery
Pain or Discomfort
Most patients have minimal pain after Mohs surgery that is usually controlled by taking acetaminophen (Tylenol®). You should avoid products containing aspirin or ibuprofen as these can promote bleeding. In some cases, our Mohs surgeon may prescribe a stronger medication for pain.
Drinking alcohol may increase your risk of bruising, so please refrain from drinking alcohol one day prior and two days after your surgery.
Wound Care
The Mohs surgery clinical staff explains and demonstrates the techniques for wound care immediately after Mohs surgery. You will receive written instructions and information for contacting the Mohs surgeon directly, in the rare case of an emergency.
In order to protect the surgical wound, you should avoid strenuous activities for at least one week after surgery. You should prepare for the possibility of visible swelling, redness and bruising for one or two weeks after surgery, especially if the skin cancer is on the central face (forehead, eyes, nose or lips).
Scarring and Healing
Any surgery to remove skin cancer results in a scar. However, the precision of the Mohs technique helps decrease the amount of scarring by removing all of the diseased skin while leaving behind as much healthy skin as possible. Our expert Mohs surgeon repairs surgical wounds to make the scar as minimal and unnoticeable as possible.
Most patients heal well and do not require additional treatment for their scars. However, patients with concerns about the scarring or healing process should contact us at 484-785-3376.
Follow-up Care
Patients usually return in one to two weeks to have their stitches removed and to ensure that the wound is healing well. You may need to return for additional visits to ensure that the scar has healed with the best possible result. It is important for you to return to your referring dermatologist or primary care provider for regular skin checkups to look for any new skin cancers.
Skin Cancer Recurrence Rates After Mohs Surgery
Approximately one to two percent of skin cancers may grow back after Mohs micrographic surgery. For certain high-risk skin cancers, the recurrence rate may be higher.
Since there is a slim chance the skin cancer may grow back, Brinton Lake Dermatology recommends consistent monitoring of the surgical site, as well as all other areas of the body for any signs of skin cancer. Patients should contact Brinton Lake Dermatology or the referring health care provider for evaluation if they have any concerns that the skin cancer may be growing back.
Adopting Sun-Smart Habits
Adopting sun-smart habits and performing regular self-skin examinations are critical to keeping skin healthy and cancer free. We recommend that all patients adopt these sun-smart habits including:
- Faithful avoidance of harmful ultraviolet (UV) rays from the sun (or from tanning salons), especially between the peak hours of 10 am to 4 pm
- Sensible coverage with clothing, including a broad-brimmed hat, long sleeves and pants, whenever possible
- Daily use of a broad-spectrum sunscreen (UVA/UVB protection) with a sun protection factor (SPF) of 30 or higher on areas of exposed skin
- Be aware of any new or existing lesion on your skin that appear to be growing or bleeding intermittently
- Talk to your doctor about characteristics of skin cancer
Post-Op and Wound Care Instructions
Medications
Your surgeon may have prescribed an oral antibiotic that should be taken with food as directed until you complete the prescription.
Dressing Changes
Keep wound dry, clean and covered for 24 hours after procedure (unless instructed for 48 hours).
Beginning the day after surgery, change your dressing once or twice a day.
- Wash hands and remove dressing after 24 hours.
- Gently clean wound with soap and water. Rinse with water and pat the wound dry with gauze or a dry cloth.
- Apply a generous amount of Vaseline ointment directly to the wound; place a non-stick bandage over the Vaseline.
- Secure non-stick dressing with paper tape to obtain an airtight bandage. A “band-aid” does not provide an airtight bandage.
Continue the above instructions once/twice daily until your next appointment.
What to Expect After Surgery
- Swelling and redness may occur around the wound for several days.
- If you experience any discomfort, you may take acetaminophen (Tylenol) as directed.
- If bleeding occurs, apply firm, constant pressure to the dressing with fingertips and a dry cloth for 20 minutes. If bleeding continues, call the doctor.
- When possible, keep the area elevated. For sites on the head or neck, try sleeping with extra pillows.
Do not do any heavy lifting, exercise, or strenuous activity for one month after surgery
Call Us If:
- Bleeding that you cannot stop occurs.
- You notice rapid swelling of the surgical area.
- You experience significant pain that does not resolve with Tylenol.
- You develop a fever.
- You have other questions or concerns about your wound.
Return to our office in seven to 14 days or sooner with any concerns.
Remember: Greasy, covered wounds heal more quickly and with less scarring. Keep your wound covered with Vaseline and a dressing at all times. Never let the area dry out or scab.
In case of an emergency after office hours proceed to the Emergency Room.