PRE-OPERATIVE INSTRUCTIONS

MOHS MICROGRAPHIC SURGERY

Mohs Micrographic Surgery is a technique whereby skin cancers are treated and removed under complete microscopic control.  It offers the highest cure rates for skin cancer.  However, because of its complexity, it is employed only for those cases where other treatments have failed to cure the cancer or where other techniques have a significantly lower chance to achieve a cure.

The surgery is performed on an outpatient basis with hospitalization only rarely needed.   Briefly, the technique is performed as follows:  A local anesthetic is injected to numb the area to be treated.  The visible tumor is then surgically removed. In the area under and around this, a thin layer of tissue is removed and cut into small pieces, each of which is color coded. This and succeeding layers of tissue are taken to find and remove the roots of the tumor.  To remember exactly where each piece of tissue came from, the doctor draws a map corresponding exactly to the wound he has created.  The tissue is then brought into an adjoining lab where the technician makes horizontal frozen section slides.  These slides, when seen under the microscope, allow the doctor to examine the entire base and periphery of the tissue that was removed from the patient.  If any remaining tumor is seen, through use of the color coded edges, the doctor is able to mark its exact location on the map.  The patient would then be brought back into the operating room where the doctor would remove a second thin layer of tissue under and around the remaining tumor, examining that in the manner previously described.  The process continues until the entire tumor has been removed.

 Once a tumor-free layer of tissue has been reached, the Mohs surgery is complete.  The number of stages or layers that must be taken from any individual is variable and depends upon the size and depth of the tumor.  On an average, most patients have two or three stages performed.

 Once the surgery is complete, the doctor must decide how the wound should be treated.  Often, reconstructive (plastic) surgery is felt to be necessary to get the best possible result.  Usually, this is done the same day of the Mohs surgery.  Sometimes, it is best to let the wound heal on its own.

 

PREPARATION FOR SURGERY

 

Importantly, if you suffer from high blood pressure, it must be under good control prior to surgery.  Please have it checked and continue your medications.

 For aches and pains, we ask that you do not take aspirin or other anti-inflammatory drugs (such as Motrin, ibuprofen, Aleve, etc…), for seven days before your scheduled surgery. You may take Tylenol (acetaminophen) for pain as needed. You should continue to take aspirin or other blood thinners if prescribed or recommended by your doctor. The following supplements should be discontinued prior to surgery;

Bromelain 2 weeks

Chondroitin 2-3 weeks

Dong quai 2-3 weeks

Feverfew one week

Garlic one week

Ginger one week

Ginko biloba 36 hours

Ginseng one week

Omega-3 / Fish Oil 2-3 weeks

Saw palmetto 2-3 weeks

Vitamin E 2-3 weeks    

If you have questions regarding taking any of your medications before surgery, our nurses will be happy to answer them.

 To avoid infection, it is important to wash your body thoroughly the day before surgery.  Specifically:

  • If your cancer is on your head, wash your face with standard antibacterial soap AND your hair with soap or shampoo and then avoid putting anything else on your face or hair (like make-up or conditioner).

  • If your cancer is on your neck or body, please buy soap with 2-4% chlorhexidine (common brand name Hibiclens) from your local pharmacy, and then gently lather your body for 3 minutes before rinsing; AVOID applying this on your face since it can be damaging to the eyes and ears.

 On the day of surgery, please arrive at Dr. Witheiler’s office at your scheduled time.   It is important that you bring with you your medications or a detailed list of all medications that you take, including non-prescription drugs.  You should eat breakfast, and take your usual daily medications that morning. If having surgery on your face, please do not wear any cosmetics. You will be brought into the surgical suite by one of our nurses who will check your blood pressure, and pulse.   Surgery will then begin and, as described above, will continue on a layer by layer basis until the entire tumor has been removed.  Between each stage you will have a dressing placed on your wound and be taken back to the waiting room.  There is a cafeteria which you can use for lunch during one of your waiting periods.  It is a good idea to bring some reading material and we strongly request that a family member be with you.  Specifically, we request that someone be able to drive you home following the completion of surgery.   Although you may be finished earlier, please plan on spending the entire day with us.

 For those of you coming from far away, we do at times require that you stay in town after your surgery allowing us to check the surgical site or to perform your reconstruction the next day.  We will be happy to set that up for you if necessary.

 With regard to billing we ask that you bring your primary and secondary insurance cards and any required billing forms.  Billing representatives are available Monday through Friday at our office to answer questions.  We are pleased to have you as our patient and to be able to offer you this highly effective surgical technique.  If you have any questions, please feel free to call before or after your surgery.

  

POST OPERATIVE WOUND CARE-SUPPLIES NEEDED

Specific wound care instructions will be given to you after surgery; however, in most situations, you will need to have the following on hand. All are available at the drugstore.

 FOR PAIN: Post-operative pain is usually minimal.  If you are given a prescription for pain, follow the instructions on the prescription.  If you are NOT given a prescription your pain can be controlled by taking acetaminophen (Tylenol) with or without ibuprofen (Motrin/Advil). 

Instructions for OTC pain relief:  acetaminophen (extra strength Tylenol) 500mg, two tablets every 6 hours (or every 8 hours if you are over 60) usually relieves any pain you may have.  If needed, you can take ibuprofen (Motrin/Advil) 200mg, two tablets, every 6 hours; try to take these between your acetaminophen doses so you always have pain control.

 

FOR WOUND DRESSING:

  • Telfa non stick pads or similar material.

  • Paper tape (easiest on most peoples’ skin).

  • Ointment- Vaseline or other plain white petroleum jelly; Polysporin or Aquaphor ointments may also be used.

  • Scissors which have been cleaned with soap and water or alcohol.

 Pre-made wound care kits are available to purchase in our office for $15 or $20

 

 FOR SWELLING OR BRUISING:  An ice pack is useful in controlling swelling and bruising after surgery you can make an ice pack using Ziploc bags and ice cubes.

Overnight Accommodations

 

Guest Suites at Methodist Hospital: (214) 947-3468      

Holiday Inn Market Center: (214) 219-3333

Candlewood Suites: (214) 631-3333