Surgical Patient Guidelines

Are you scheduled for Mohs Surgery? To ensure your surgical experience is smooth, we have provided instructions.

You have been scheduled for Mohs surgery. There are several things you need to do to prepare for the surgery:

  • Be prepared to spend the entire day at our office. We process your tissue in our office lab, which takes at least 1 hour. If the tissue shows cancer extending to the margin, an additional portion of tissue will be taken. This process continues until all of the cancer has been removed. Once the margins are clear of cancer, your surgeon will repair the defect.
  • We are happy to provide beverages and snacks in our lobby while you wait. However, you may need to bring lunch in case you stay through the afternoon.
  • On the morning of surgery, wash well the area upon which you are to have surgery with an antibacterial soap such as Dial. EAT A GOOD BREAKFAST AND TAKE ALL DAILY MEDICATIONS. Bring any medications that need to be taken throughout the day.
  • If surgery involves your face, DO NOT apply any cosmetics/makeup.
  • Avoid alcohol for 24 hours prior to surgery. Do not smoke or chew tobacco 24 hours prior to surgery or after surgery as this will interfere with healing.
  • If not prescribed by your doctor, avoid anti-inflammatory medications two weeks prior to surgery. For example: Advil, Aleve, Alka Seltzer, Anacin, Bufferin, Cliniril, Emprin, Equagesic, Excedrin, Fiorinal, Ibuprofen, Naprosyn, Norgesic, Nuprin, Trilisate, Vitamin E, Fish Oil, Garlic, Ginko Biloba. Take Tylenol for pain relief if needed.
  • If you take Coumadin, Plavix, aspirin or any other prescription blood thinner, we recommend you stay on that medication unless otherwise suggested by the prescribing physician. DO NOT STOP THESE MEDICATIONS ON YOUR OWN.
  • If you notice a significant increase in the size of the cancer between the time we see you and the scheduled date for surgery, please contact our office as we may need to re-evaluate and possibly schedule surgery sooner.
  • DUE TO THE LIMITED AMOUNT OF SPACE IN OUR WAITING AREA, PLEASE BRING ONLY 1 FAMILY MEMBER/DRIVER TO ACCOMPANY YOU. We appreciate your understanding of this request.

 

Wound Care Following Biopsy

  • Keep the bandage on for 24 hours, then remove the bandage and shower as usual.
  • Clean biopsy site with soap and water and keep area covered with Vaseline and Band-Aid.
  • DO NOT allow a scab to form. If a scab forms, gently remove it with soap and water and apply Vaseline and a clean bandage. Keep the area covered until completely healed (approximately 1 to 2 weeks). Legs or large lesions may require longer to heal (1 to 2 weeks).
  • If you have stitches in your biopsy site, keep the site clean with soap and water and apply Vaseline and a clean bandage daily until sutures are removed.
  • INFECTION: Mild redness is normal, but if your biopsy site becomes red, tender, or swollen with foul smelling drainage, please contact our office immediately.
  • We will call you in approximately one week with your biopsy results and schedule further treatment if this is determined to be necessary. If you do not hear from us in two weeks, please call our office so that we may follow up on your results.

 

Mohs Surgery Post-Operative Instructions and Wound Care

  • After surgery, try to spend the remainder of the day quietly resting. Limiting your exertion and movement will give you the best chance of keeping your wound closed so that it heals properly.
  • Keep the dressing clean and dry and in-place for 48 hours. If the dressing becomes heavily soiled or wet, gently remove at once and apply a new clean dressing. After 48 hours, remove the dressing and gently wash the surgical site with soap and water and remove the crust that has formed and apply petroleum jelly and a new dressing. Many people are now allergic to antibiotic ointments (eg, Neosporin, triple antibiotic ointment, polysporin) and a perceived infection may actually be an allergic reaction to the antibiotic ointment. Clean the wound twice daily and keep the area covered until the stitches come out. DO NOT let a scab form. DO NOT go swimming or completely submerge the area in water until the sutures have been removed.
  • If desired, apply ice under a washcloth for 20 minutes on and 20 minutes off, for the first few hours after surgery to minimize bruising and swelling and to shorten the recovery time.
  • To reduce the chances of BLEEDING, DO NOT drink alcohol or take any aspirin or non-steroidal anti-inflammatory medications (Ibuprofen or Motrin) for at least 24 hours after surgery unless prescribed by your physician.
  • Some BLEEDING is normal. If you experience bleeding after surgery, apply moderately firm pressure on the dressing for 15-30 minutes. The oozing should stop; if it doesn't, please contact our office. If bleeding is profuse go to the nearest emergency room.
  • Pain and swelling at the site is common. Elevate the area, if possible, above the heart to reduce swelling and pain. If surgery was on the head, neck, or face avoid stooping, bending, or heavy lifting. Sleep with your head and shoulders elevated on several pillows.
  • INFECTION: Mild redness of the wound edges is normal, but if associated swelling, more pronounced redness, yellow/green drainage or increased pain with fever and chills occurs several days after surgery, please contact our office.
  • Once the sutures are removed, the incision line and suture marks will continue to fade over weeks to months. In rare instances, a wound may heal with a thickened scar. This usually occurs in patients with a prior history of poor healing but is also dependent upon the location of your incision. In most instances, you will be scheduled to see the doctor six weeks after your surgery to monitor your progress and ensure that the surgical site is healing properly.

 

Wound Care for Second Intention Healing Without Xeroform Dressing

  • At times, the surgical wound will be allowed to heal by itself completely. A pressure dressing will applied to help with swelling and bleeding. DO NOT remove dressing or allow it to get wet for 48 hours. After 48 hours, remove the pressure dressing. You will need to continue local wound care for several weeks.
  • Wash the site with water to remove any crust that develops within the wound. If it is prescribed by the doctor, apply Bactroban (mupirocin) ointment, otherwise apply Vaseline and cover with a bandage. Do this at least twice a day. Some bleeding may occur while cleaning the site which will stimulate granulation and wound healing. DO NOT let a scab form. If a scab forms, gently remove it with soap and water. The wound needs to maintain a "beefy" red appearance.
  • Some BLEEDING is normal. This is an open wound and you can expect some drainage from the surgical site. If you experience bleeding after surgery, apply moderately firm pressure on the dressing for at least 20 minutes. If bleeding is profuse and saturates your dressing, please contact our office right away for additional instructions.

With Xeroform Dressing

  • For a larger wound defect, an antibiotic dressing (Xeroform) may be sewn in before covering the site with a pressure dressing. DO NOT remove the pressure dressing or get it wet for the first 48 hours.
  • Some BLEEDING is normal and may cause the yellow Xeroform dressing to appear red or brown in color. If you experience bleeding after surgery, apply moderately firm pressure on the dressing for at least 20 minutes. If bleeding is profuse, please contact our office immediately for additional instructions or go to the emergency room.
  • The Xeroform dressing will be removed in the office, usually after one week. Once the dressing is removed, you will need to continue local wound care for several weeks. Wash the site with soap and water to remove any crust that develops within the wound. If it is prescribed by your doctor, apply Bactroban (mupirocin) ointment, otherwise apply Vaseline and cover with a bandage. Do this at least twice a day. Some bleeding may occur while cleaning the site, which will help stimulate granulation and wound healing. DO NOT let a scab form. If a scab forms, gently remove it with soap and water. The wound needs to keep a ┬áred appearance.
  • INFECTION: Mild redness of the wound edges is normal, but if associated swelling, more pronounced redness, yellow/green drainage, foul odor or increased pain with fever and chills occurs several days after surgery, please contact our office right away.

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