MOHS MICROGRAPHIC SURGERY

OVERVIEW: Mohs micrographic surgery is the most effective and advanced treatment for skin cancer today. The procedure is performed by a fellowship trained Mohs surgeon in an outpatient office setting using local anesthesia over the course of a single day; any needed repair is usually done the same day at the same location by the same Mohs surgeon.  For more of an overview about Mohs surgery click on the following link: https://www.mohscollege.org/for-patients/about-mohs-surgery/overview-of-mohs-micrographic-surgery

Please review all the information below and remember to plan on spending the day at the office, though your visit might be shorter.  While there is food relatively near our office, it is best to bring snacks, drink, and something to do to pass the time since you will be waiting a lot between procedures.

GENERAL INFORMATION: For some more information about what to expect before, during and after Mohs surgery, click on the following link: https://www.mohscollege.org/for-patients/about-mohs-surgery/the-mohs-surgery-procedure

 PREOPERATIVE INSTRUCTIONS: For Dr. Witheiler’s specific preoperative Mohs instructions, click on the following link: (NEED LINK HERE)

 

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