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Mohs’ Micrographic Surgery – Patient Instructions

Smoking adversely affects wound healing. It is recommended that patients stop smoking for at least 2 weeks before surgery and 2-4 weeks after surgery. This is especially important for tumors that are on the nose or on the leg.

Please notify our office before the day of surgery (preferably at least one week in advance) if any of the following apply:
If you have taken AccutaneÒ in the previous 6 to 12 months, history of keloids or thick scarring.
If you are taking aspirin, ibuprofen, or any other anti-inflammatory medications (commonly found in headache preparations, arthritis medications, and menstrual cramp relievers) call us. If your doctor has recommended that you take aspirin, you need to contact your doctor to ensure that it is O.K. to stop. It is recommended that one stop aspirin for 10 days before the procedure. For other non-steroidal anti-inflammatories (i.e. ibuprofen), it is recommended that one stop them at least 3 days before the procedure. It is recommended that one stop taking Vitamin E for at least one week and refrain from consuming alcoholic beverages for 3 days before the procedure.
If you are taking Coumadin (although in nearly all cases it is NOT recommended that one discontinue this medication) we need to be advised that you are taking it. Do NOT stop your Coumadin unless you are advised to do so IN WRITING by OUR office.
If you need to take antibiotics before surgery or when you get your teeth cleaned, if you have a heart murmur, or have an artificial joint (joint replacement) within the last 2 years, please call our office so that we can prescribe an antibiotic for you. Please notify us if you are already taking an antibiotic for any other reason. The antibiotics used for skin surgery are DIFFERENT than amoxicillin, which is given prior to dental procedures–you will need to take a different type of antibiotic.
In some cases, stitches are used that do not dissolve. In these circumstances you must return to have your sutures removed, which is usually 7 days after surgery, although can be as long as 3 weeks for tumors on a leg. If this is a problem, call our office!

Two Days Before Treatment (for lesions that are below neck)
Purchase HIBICLENS from a local pharmacy. Twice daily on the day before surgery and on the morning of surgery, scrub with solution from the neck down, leave on for 5 minutes and then rinse off with water only. Pat dry with a clean towel and put on clean clothes. Do not apply any other soaps, lotions, powders or perfumes to the cleansed areas. If time does not permit on the morning of surgery, cleanse the surgery site only. DO NOT USE IN GROIN OR ABOVE THE NECK. THIS PRODUCT CAN CAUSE DAMAGE TO THE EYES AND EARS!

Before the Day of Treatment
You may want to buy supplies to care for the surgery site.
For tumors on the face, often no care is required. In some cases, one may be asked to use antibiotic ointment (i.e. PolysporinÒ ointment, unless you are allergic), hydrogen peroxide, and cotton swabs are usually all that is needed. Some patients prefer to cover the surgical site with a bandage. If a bandage is desired, TelfaÒ gauze and paper tape is recommended and is available at any pharmacy.
For tumors that are not on the face, care often is not required. Some patients choose to keep the surgery site covered, especially if it is in an area that can become irritated by clothing. In this case, we recommend purchasing an antibiotic ointment (i.e. PolysporinÒ ointment, unless you are allergic), hydrogen peroxide, cotton swabs, TelfaÒ gauze and paper tape, all of which are available at any pharmacy.
Some patients may wish to apply ice to the area (for tumors on the lip or around the eyes) A bag of frozen peas or corn applied 20 minutes every hour is recommended.
Although most patients have minimal discomfort that rarely requires any medication, TylenolÒ is the only recommended medication.
If prescribed, do not forget to take your antibiotics on the day of the procedure. Put it in a place where you will remember to take it. Your surgery may be cancelled or postponed if one does not take the antibiotic that we prescribe–if applicable.

Plan ahead. You may not be allowed to shower or bathe for 48 hours after surgery. In some cases, you may be required to keep the surgical site dry for one week (which is not uncommon for some tumors on the lower nose, ear, or eyelid). Therefore, plan on showering on the day of surgery or the night before.

You are responsible for locating the site of the cancer–knowing exactly where it is. If you have a caregiver or significant other that has cared for the biopsy site and is unable to come in on the day of surgery, have him or her circle the biopsy site. In some cases that biopsy heals up extremely well with little evidence of tumor. For this reason, it is recommended that the site be checked daily and marked with a regular ballpoint pen if necessary.

The planning of the Mohs’ procedure requires significant time on our part and we allot a substantial amount of time for each patient. For this reason, many patients must wait several weeks to have the Mohs’ procedure performed. Therefore, we ask that if you have any reservations about having the procedure done or have questions that might influence your decision to proceed, please arrange for a consultation before the day of the procedure to address them and not to wait until the day of surgery.

Get a good nights rest before the procedure.

Day of Treatment
Do not consume any CAFFEINE as this can elevate your blood pressure.
Please do not apply any make-up, powder, sunscreens, moisturizers, lotions, or creams to the area to be treated.
Wear clothing that is easy to put on and take off. For tumors on the face, it is recommended that one wear a button down shirt.
Take all of your regular medications (i.e. blood pressure medications), except those which you were specifically informed not to take (i.e. aspirin for some patients). Don’t forget to take your antibiotics, if prescribed.
Unless arranged with the staff in advance, no other problems will be addressed on the day of surgery unless it is urgent. For this reason we kindly ask that you reserve any questions not pertaining to the surgery for another day or at the time of suture removal or wound check.
Eat a good breakfast and bring a snack and reading materials with you to occupy your time.
Do not make any plans for the entire day! Although most patients are out within 3 hours, it is not rare for patients to spend the entire day and even early evening in our office. For this reason, we ask that you expect to spend the day with us. In short, MAKE NO PLANS FOR THE DAY.

What to expect after surgery
For tumors on the face, bending and lifting should be avoided for one week.
One should discontinue exercise or other strenuous activities, including golf and tennis, for at least one week unless otherwise instructed.
For tumors on the trunk, arms, or legs, avoidance of strenuous activities, including bending or stretching may be necessary for more than two weeks.
The treatment of tumors around the eyes, including the forehead, may result in a black eye.
Patients should not take aspirin, non-steroidal anti-inflammatories (i.e. ibuprofen), Vitamin E, or consume alcoholic beverages for at least 48 hours unless otherwise instructed.
Usually there is no discomfort felt after the procedure. If there is any mild discomfort, only Tylenol should be taken.
You may be instructed to go directly home after surgery. It is recommended to prepare you house prior to surgery by stocking up on groceries and any other items that you may need.