It is important to realize that Mohs surgery does require some time. The main reason for this is that the tissue is processed in our onsite lab while the patient waits. Most Mohs surgeries take 2-4 hours to complete, but more complicated cases can take a good portion of the day, multiple Mohs stages take time to complete. That is why Mohs surgery is often referred to as an "all-day" technique, though this is rarely the case. As a result, the procedure is scheduled in the morning or early afternoon.
Once the patient arrives, he or she is prepared for surgery. The site is identified, local anesthetic is administered and the tissues are removed. Before the patient leaves the room, the area is bandaged. The tissue is then taken to our laboratory while the patient waits in the appropriate area. The laboratory portion of the process can range from 30 minutes to an hour or more. This depends on the size and complexity of your tumor. If the removed tissue is found to still contain skin cancer, at the examined margins, the procedure will be repeated as soon as possible. In fact, several excisions and microscopic examinations may be done in one day. Rarely, it is necessary for the patient to return the next day for further surgery.
It is important to be prepared for the aforementioned waiting that is involved with the procedure. Our facility has two waiting areas to help make this period more comfortable. One room has a television and the other room is a quiet room with recliners where patients can read or just relax.
After the skin cancer has been completely removed by the Mohs technique, a decision is made to determine the best method for treating the wound created by the surgery. These methods include letting the wound heal on its own, or closing the wound through a variety of suturing techniques. The repair is usually performed on the same day as the removal. In some instances, you may need to return to have the wound repaired on a different day, if it is advantageous to do so. The Mohs technique is strictly outpatient. However, on rare occasions, patients may require hospitalization. This possibility will be considered during your consultation.
You may also elect to have the wound repaired by your referring physician or another physician. There are certain instances where this may be preferable. This will also be discussed during your consultation.
After surgery, you will need to care for your surgical site. Printed instructions will be available in the office after your surgery is complete. You should plan on wearing a bandage for at least 7 days after your surgery. Also, you should plan to avoid strenuous physical activity for at least 48 hours after surgery. You should not plan athletic or exercise activities for 2-3 weeks after surgery. Refraining from these activities will facilitate proper healing, which will improve your outcome.
The following are a few things to consider when preparing for your Mohs surgery.
1. Bring something to do. You will have a lot of free time while you are waiting for your Mohs stages to be prepared. Bring books, puzzles, paperwork or anything that you like to do to pass the time.
2. Eat a full breakfast or lunch (depending on when your Mohs surgery is scheduled). Also, bring a lunch or a snack, as you may get hungry while you are waiting.
3. Dress comfortably and bring something warm to wear. The building is kept on the cooler side while we are doing Mohs to facilitiate the frozen tissue processing. It is a good idea to bring a light jacket or a light blanket if you are cold natured. Also, wear casual clothing as your clothing may be stained by blood or surgical preps.
4. Take all of your prescribed medications. Bring your medications with you as you may need to take them during the course of the day. If you are diabetic, bring your testing items with you. If you are taking blood thinners, we will discuss options to help manage this during the perioperative period.
Avoid taking medications, that will promote free bleeding. If you are on these medications under the direction of a physician, you may continue to take them. This will be determined during your preoperative consultation.
The following list of drugs includes many, but not all, drugs that can impair normal clotting mechanisms. For example Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as aspirin and ibuprofen, bind to blood platelets and impair platelet during blood coagulation. Alcohol and vitamin E also impair clotting. Coumadin (warfarin), which impairs clotting by competing with vitamin K, is given to patients who have a illness that causes excessive clotting.
4-Way Cold Tabs
To get more information on what to expect preoperatively, be sure to check out the preoperative checklist in the “For Patients” section of the website.
Crescent DermSurgery is a spacious 4400 square foot facility in Metairie, which is easily accessible from the greater New Orleans area and its surrounding parishes. Detailed directions to our facility can be found in the Contact Us section of the website. Our facility offers easy front door parking, which makes it easy for patients to get into and out of the clinic. You won’t have to deal with parking garages and other hassles associated with larger hospital based facilities. We also have two patient waiting areas to ensure your time with us is comfortable. One patient waiting area has a television so you can watch some TV while you await your results. We also have another quiet waiting area with recliners where you can just relax and read or nap. We have three minor procedure rooms and two larger procedure area. This gives us ample space to take care of you in a professional and safe manner. Our lab is CLIA certified so you know that your lab specimens are being prepared to the highest standards. While we have the amenities that can be found in larger hospital based clinics, our facility is still an outpatient clinic based facility. This means that we provide you with excellent care without charging hospital based facility fees, which can substantially increase the cost of the procedure. Crescent DermSurgery also has a sister facility in Gulfport, Mississippi to provide the same level of service to the people whom require our services along the Mississippi Gulf Coast. To learn more about our Gulfport location, please click the following link www.moderndermgulfport.com
1. Bring Something to Do. For the one hour-long waiting periods, bring books or work to occupy yourself. If you’re having surgery near your forehead, upper nose, or eyes, it is normal to experience swelling and to have a bulky dressing that may block your vision. This may make reading or watching television difficult while you’re in the waiting room. So, to entertain yourself, consider bringing something to listen to with earphones, of course.
2. Antibiotics. If I’ve prescribed antibiotics for you, start taking them before surgery as we have instructed. Continue taking your antibiotics according to the directions until you have finished every last pill, even after surgery. If, at the time of our surgery, another physician has prescribed for you an antibiotic, you must notify our office — you should not be on 2 antibiotics at the same time unless it has been OK’d by our office and your prescribing physician.
3. Medications. Unless otherwise advised, it is important to take your regular medications — including your antibiotics — on the morning of your surgery.
a. Aspirin. If you are taking any amount of aspirin on a daily basis, please notify our staff. We generally allow you to continue taking your aspirin, but we may ask you to stop it. If you do stop taking aspirin, you will be able to resume your regimen two days after surgery unless otherwise directed.
b. Blood thinners- If you are on prescription blood thinners continue to take them as directed, unless told to discontinue them by our office. We will discuss possible discontinuation of you blood thinners pre operatively at the time of your preoperative consult.
c. Diabetes medications- If you are on insulin or other medication to control your blood sugar, bring them with you. Also, bring any diabetic testing supplies that you may need to monitor you blood sugar during the course of the day.
4. Vitamin E. Do not take Vitamin E two weeks before surgery. Like aspirin, Vitamin E can increase bleeding during surgery and recuperation. It is permissible, however, to take Vitamin E contained in a multivitamin tablet.
5. Pain Relief. Do not take any non-steroidal anti-inflammatory agents, such as Motrin, Ibuprofen, Advil, Celebrex, Nuprin, Feldene, Clinoril, Alleve, Naprosyn, or Anaprox for two days before surgery. For minor aches, pains, and headaches, take regular or extra- strength Tylenol (Acetaminophen), as directed on the label.
6. Supplements. Do not take any supplemental garlic tablets or Gingko biloba for two weeks before surgery.
7. Alcohol. Do not consume alcoholic beverages — beer, wine, liquor — for three days before, and three days after surgery.
8. Tobacco products. If possible, stop smoking or using the these products — or attempt to reduce their use significantly — for at least two weeks before and after surgery. Nicotine products deprive the blood of oxygen and constrict blood flow, which is needed for proper wound healing. The use of products containing nicotine may cause the death of a graft or flap (common reconstructive procedures). This could necessitate additional surgery or result in an unsightly wound.
9. Contact Lenses. Do not wear them on the day of surgery. Instead, wear glasses.
10. Clothing. Do not wear your finest clothing on your surgery day. We recommend wearing a button-down shirt that will not disrupt your post-operative dressing when changing later that night. Wear something that you wouldn’t mind being stained by blood or surgical preparations.
11. Bathing. On the morning of your surgery, you may bathe or shower normally. If you get your hair done on a weekly basis, remember to get your hair washed the day before surgery. You will not be allowed to wet your surgical site for, at least, 24 hours.
12. Eating. On the morning of your surgery, have breakfast. But limit your intake of caffeinated beverages. Bring Snacks. Because your day here could be long, you may bring snacks or lunch with you. If you are following up with another surgeon for reconstruction, you must receive permission to eat from your repairing physician.
13. Bring a Sweater. The office waiting area is always very cool, regardless of the temperature outside. To stay warm, bring a sweater, preferably a sweater or jacket that buttons or zips down the front and will not disturb your dressing during removal.
14. Other Appointments. It is important for you to realize, no matter how small the skin cancer appears to be, looks can be deceiving. Since your surgery may last the entire day, you must not schedule any other appointments for that day.
15. Special Occasions. Facial surgery often creates swelling and bruising. Also, the post- operative dressing may be rather large and obvious. Keep this in mind as you arrange your social and/or work schedule. If an important event is already planned, please check with your referring physician or me to see if the surgery can be postponed for two or three weeks.
16. Stay Close. Remember to be available to have your stitches removed in follow-up visits in one, two, and three weeks after surgery. Do not travel overseas for two weeks after surgery — a routine medical precaution.
17. Plan Your Meals. If you’re having surgery near the lips, you may experience significant swelling for a few days to a few weeks. Immediately after surgery, limit your meals to soft foods — such as eggs, yogurt, and those that are pureed in a food processor or blender. Or stock up on such products as Slim Fast, Ensure, and Sustecal (available without a prescription in drug stores). After 5 to 7 days, you may have pasta, chopped meats, and small bites of chicken or fish.
Immediately after surgery you will be told when your first follow-up appointment is, and we will be happy to see you frequently until we are both satisfied with your outcome. In order to avoid complications, I encourage all my patients to call as questions arise between their appointments. It is better to be safe than sorry.
When thinking about Mohs surgery, it is important to do a preoperative consultation. This allows for the patient to learn about the procedure as well as be informed about particular details of the procedure that may be different depending on the patient’s particular situation. The consultation also allows the doctor to personally evaluate the patient and to prepare appropriately for the upcoming surgery. If you have had Mohs surgery before and are familiar with procedure, it is still good to have a consultation. Each case is different and a consultation will allow the doctor to discover these details preoperatively and plan for them accordingly.
When preparing for your preoperative consultation, you should be prepared to provide certain information that will be important in preoperative planning. The following is a list of things that you should bring or prepared to answer during your consultation.
1. Bring a list of your medications. If you are taking blood thinners, such as Coumadin, be prepared to tell us when you are scheduled to have your bleeding parameters and INR checked.
2. Bring your pathology report. In most instances, the pathology report has been sent over by your referring physician. If you are self referring, it is important that you bring your pathology report. If you do not have it, you can call our office when making the appointment and we will call the physician who did the biopsy to get the report before the consultation. You may have to sign a HIPPA release form so we can get the required information from your doctor. If you are being referred to us for evaluation of a lesion and you did not have a prior biopsy, we may perform the biopsy during your consultation.
3. If you have any implanted devices in your body, be prepared to provide information regarding when they were implanted. Implanted devices can include a number of items, such as artificial joints, plates, heart stents, intravascular stents or cages, pacemakers or cardiac defibrillators and neurostimulators.
If you have any questions regarding your preoperative consultation, feel free to call us before you come. Our office number is 504-570-6370.