What to Expect on Your Day of Surgery
On the Day of Surgery
- The length of the surgery varies depending on the complexity of the skin cancer and the type of reconstruction required. It usually takes between 3-4 hours. Occasionally, the procedure takes longer, so we ask that you come prepared to spend the day. Much of the time will be spent waiting for the tissue to be processed in the lab. Please bring reading material and anything else you think will help you be comfortable during your time with us.
- Be sure to eat a good breakfast, and feel free to bring a snack/lunch. It is important to stay well hydrated.
- Take all of your usual medications, including blood-thinning medications, as prescribed. Please bring a complete list of your medications with you.
- To improve the cleanliness of the skin treatment site, please take a shower and wash your hair. Do not apply makeup in the area of your surgery.
- Consider wearing clothing with buttons and bring layers, as the surgical suite may be cold.
- You may bring a family member or friend with you. You may need someone to drive you, especially if your surgery involves your central face area, hand, or leg (required if by the eye or if you take a medication that helps to calm your nerves).
- Ensure that you are able to identify the biopsy site or that our office has a photo (photos are taken prior to biopsy at Novem Dermatology and in our system).
About the surgery
Mohs Technique: Once you are in the procedure room, the area surrounding the skin cancer will be further cleaned and a local anesthetic will be used to numb the site (likely similar to when the biopsy was performed). Dr. Howe will then remove a thin layer of tissue around the skin cancer and take it to the in-house laboratory for processing. Dr. Howe will examine the removed tissue under a microscope and locate any remaining cancer cells. If cancer remains, you will be brought back to the procedure room where more tissue from the involved area will be removed and then processed.
Reconstruction: After the skin cancer has been completely removed, Dr. Howe will discuss the various methods of reconstruction for your particular wound. This depends on the wound’s size, depth, and location. Small surgical wounds or those on the leg may be allowed to heal without stitches. Many wounds will be closed with stitches in a side-to-side fashion; others may require a flap (rearranging skin from near the wound) or graft (borrowing skin from another site to cover the wound). In certain cases, it may be recommended to let the wound heal on its own. Dr. Howe will work with you to provide the best functional and cosmetic outcome.
After Mohs Surgery: You will have a bulky bandage placed over the surgical site after your surgery. This first bandage will need to remain dry for 24-48 hours. Please plan to rest for the remainder of the day (do not go back to work). You should plan on keeping your wound covered and avoid strenuous physical activities for at least 1-2 weeks. Detailed written instructions about the required wound care and the needed supplies will be provided after your surgery is complete. You will likely return in one-six weeks for stitch removal or wound check. Most patients report minimal pain that responds to a combination of acetaminophen (Tylenol) and ibuprofen (Advil).
Commonly Asked Questions
Should any medications be stopped?
All medications prescribed by your doctor should be continued. Please do STOP taking all over-the-counter medications and supplements that were not prescribed by a doctor 7-10 days before and after your surgery. These include aspirin, Vitamin E, and nutritional and health-food supplements. Patients that take Coumadin (warfarin) should have a routine blood study (PT/INR) drawn within a couple weeks of Mohs surgery. This can be faxed to the office (813) 590-2125.
Do I need to take antibiotics?
Antibiotics are not commonly prescribed for Mohs surgery. However, it is occasionally recommended to take them 30-60 minutes prior to surgery for patients that have: artificial heart valves, history of endocarditis/infected heart valves, severe dysfunction of a heart valve, and in rare cases, a joint replacement in the last couple of months. Patients that have any of these conditions should call our office prior to their surgery so that the appropriate antibiotic can be prescribed.
Will I have a scar?
Any surgery results in a scar. However, the precision of the Mohs technique helps decrease the amount of scarring by removal of all the diseased skin while leaving behind as much healthy skin as possible. Dr. Howe is skilled in surgical reconstruction and repairs wounds to minimize the scar as much as possible. Most patients heal well and do not require additional treatment to their scars. 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).
How will I take care of the wound?
Our clinical staff will explain and demonstrate the technique for wound care immediately following your surgery. You will receive written instruction and information for contacting us in the rare case of an emergency. Typical supplies that you will need to get to take care of the wound: cotton tip applicators or Qtips, a squeeze tube (ideally new) of Vaseline/petroleum Jelly /aquaphor, non-adherent (Telfa) dressing pads, Hypafix or paper tape (1/2” or 1”).
Will I be put to sleep for the surgery?
No. The surgery is performed under local anesthesia, meaning you will be awake, but the area will be numb.
Will my activity be limited following surgery?
Yes. Physical activity, including sports and exercise, are generally restricted following the surgery. If your job requires heavy lifting or physical exertion, you may need to plan to be off for a few days. Dr. Howe will give you specific instructions at the time of surgery.