Surgery Overview | How to Prepare | What to Expect | Before/After Photos | Patient Handouts
What to Expect
Day of Surgery
When you arrive for the surgery, please go to the second floor and check-in at the front desk. An assistant will then take you to a surgery room and have you sign a consent form. Your Mohs surgeon will review the plan for the procedure, answer any last minute questions, and have you confirm the correct location of the surgical site after it is outlined. The site will be cleaned with an antibacterial solution and anesthetized with local injections. After the area is numb, the tissue will be removed and a bandage will be placed over the wound. It can take up to a few hours for the lab to prepare the tissue and for your Mohs surgeon to examine it under the microscope. During this time, you can relax in our waiting room. We will have coffee and snacks available. There is also a TV and free WiFi available. It can be helpful to bring a book or tablet with you on the day of surgery. Many patients also find it nice to have a friend or family member accompany them on the day of surgery. If there is still skin cancer present at the edge of the tissue removed, additional tissue will be removed and will be checked again. This process will be repeated until the skin cancer is completely removed.
Once the skin cancer has been removed, your Mohs surgeon will determine the best way to repair to wound. The options for reconstruction include letting the wound heal on its own, closing the wound with a straight line of stitches, using a skin graft, or using a skin flap. The best method to reconstruct the wound will be determined on an individual basis and only after the skin cancer has been removed. Once the wound is repaired, a bandage will be applied. We will then review wound care instructions and provide you with a written copy to take home.
The day of surgery can be long. We will make every effort to make the day as quick as possible for you, but plan to be here most, if not all, of the day. Some patients prefer to bring a lunch from home, but there are also nearby restaurants that deliver. Our staff can provide you with a list of restaurants that deliver. If you have someone accompanying you, that person can also pick up food for you from a local restaurant. However, we ask that you remain in our office until your entire surgery is complete in case you have bleeding between procedures.
We recommend that you go home and take it easy after your surgery. The initial bandage applied after your surgery will usually remain in place for 24 hours. Most surgical sites will then require daily bandage changes for about 1 week. Detailed wound care instructions will be provided on the day of surgery and can be found here. Your wound care requirements may vary based on the type of reconstruction. A list of wound care supplies can be found here. For your convenience, wound care supplies are also available for purchase at the Dispensary in our clinic. You will typically return 1-2 weeks after the surgery for the surgical site to be examined and to have the stitches removed. In many cases we will also have you return 6-12 weeks after the surgery to ensure that the area has healed well.
Most patients have minimal pain following surgery. This pain usually responds well to Tylenol. For patients undergoing more extensive surgery, prescription pain medication will be provided. It is normal to have bruising and swelling after surgery. The bruising typically resolves within 2 weeks. In most cases, swelling will resolve within a couple of weeks. However, in some locations it can persist for a few months. It is also normal to have some numbness after surgery. This almost always returns to normal but can take 6-18 months to do so. As the nerves grow back, it is common to experience itching or a “pins and needles” sensation.
While it is impossible for a surgeon to cut the skin without leaving a scar, we will perform your reconstruction very meticulously to help ensure you have the best result possible. Most of the healing will take place over the first few weeks, but it will take 6-18 months for the scar to mature completely. Surgical sites typically feel tight and “thick” after surgery. This will improve in the few months following surgery. Massaging the scar starting about 4 weeks after the surgery can help improve the “thick” or “lumpy” feeling of the scar. Occasionally we perform secondary procedures to further improve the appearance of your scar. This may include dermabrasion or laser therapy. There are also scar creams available to further improve the appearance of your scar. For your convenience we offer scar creams for purchase within our Aesthetics Center.
The most important thing to remember following surgery for skin cancer is to follow up with your Dermatologist for regular skin exams. The frequency of skin exams will vary based on the type of skin cancer. For patients with a history of basal or squamous cell carcinoma, we typically recommend they see a Dermatologist every 6 months. After a patient has one basal or squamous cell carcinoma, the risk of that patient developing another skin cancer is about 50% over the next 5 years. For patients with melanoma, we typically recommend they see a Dermatologist every 3 months for the first 2 years then every 6 months for life. Ask your Dermatologist or Mohs surgeon if you have questions about your recommended follow up schedule.
In addition to close follow up to monitor for new skin cancers, it is also important to minimize any further sun damage. Regular use of sunscreen can reduce the risk of developing squamous cell carcinoma by 40% and can reduce the risk of developing melanoma by 50%. For your convenience we offer sunscreen for purchase at our office. Protective clothing is also a helpful tool to prevent sun damage. We don’t currently offer UV protective clothing at our office, but it can be found at several stores and online (Coolibar, SwimZip, UV Skinz).