The fellowship-trained Mohs surgeons at Braun Dermatology & Skin Cancer Center want you to be completely comfortable after you have decided on Mohs surgery. Below, you will find helpful answers to common questions.
What should I do the morning of Mohs surgery?
Unless otherwise instructed, eat your normal breakfast and take your usual medications.
Do I have to stop my blood thinners?
Unless otherwise instructed by your doctor do not stop your blood thinners.
What should I wear?
If the site is on your face, please come without makeup or earrings. Wear comfortable clothes and shoes. A button down shirt is advised so that in the event the shirt needs to be removed, it will not have to be pulled over the bandaged face. If the site is on the leg, wear loose pants that can be pulled up. If the site is on the back, wear a button down shirt without an undershirt. If the site is on the hand or arm, do not wear jewelry such as rings or watches.
How should I get to and from the appointment?
Ideally, if the surgical site is on your face, you should arrange for someone other than yourself to drive. This is due to concerns about swelling around the eyes which can occur and may impede your visual field temporarily. We are also metro-accessible (Foggy bottom metro is closest about 6 blocks) and many patients find this most convenient. There is parking in the building (alley right before the building) for $23 a day
Is it going to hurt?
Most patients are surprised at how little the whole process actually hurts. There is a small stick with a tiny needle to numb the area and very minimal discomfort, after that initial numbing. After the surgery, if there is any discomfort, over-the-counter ibuprofen or acetaminophen are typically all that are needed. When appropriate, prescription pain medications are given in case more discomfort occurs.
How long will the whole procedure take?
Plan on being with us the entire day. Most patients are finished within 3-5 hours, however, this is not guaranteed. The vast majority of the time is spent in the waiting room. Many patients bring laptops to work/watch movies, others bring a good book. There are many magazines in the office as well.
How many stages will it take to remove my cancer?
On average, 1-3 stages, but there are many times that more are required. Please understand that many tumors have microscopic "roots" or "extensions" that need to be meticulously tracked and removed with numerous stages.
Will I have stitches?
Some wounds require reconstruction or repair while others are best left open to heal. every wound is unique and often times the method of repair is not known until the cancer is completely removed. Different repair methods include a simple side-to-side closure, flaps, and grafts. We are trained not only in Mohs surgery but also in wound reconstruction. The reconstruction is performed immediately after the Mohs surgery on the same day.
Do I need to see a plastic surgeon?
In this practice, the vast majority of Mohs surgery wounds are repaired by the Mohs surgeons. Reconstruction is part of our fellowship training. However, there are certain unique circumstances that do require involving ENT or plastic surgery colleagues. If you believe that you need or want a plastic surgeon to perform your repair and you are being referred to our office from another dermatologist, please inform our surgical coordinator. You will also most likely need a consultation visit both with our office and the plastic surgeon so that the coordination can be done properly.
What should I do after the surgery?
After the surgery, go home and rest. Specific instructions will be reviewed with you after the procedure is over. We most typically recommend keeping ice on the area for 20 minutes every hour for the first day until you go to bed. It is important to elevate the area to help with swelling.To avoid bleeding or opening of the wound, we generally recommend avoiding strenuous physical activity or lifting for 7-14 days depending on the site. It is also not advisable to travel far from the DC area for the first few days after surgery so that you may be able to return to the office if concerns arise.
What should I expect after the surgery?
Swelling, bruising, and minor bleeding are commonly seen after surgery. All of this will improve dramatically over the first 2 weeks. Residual swelling is usually resolved by 2 weeks but can persist for months in a small subset of wounds. Discomfort may occur initially and is best treated with rest, ice, elevation, and ibuprofen or acetaminophen. Prescription pain medications are occasionally needed and will be given if needed.
What can I do to minimize a scar?
The best way to have the optimal outcome is to follow post-operative wound care instructions and give the wound time to heal. There is no way to remove cancer surgically without having a scar but faces often heal so well that it is difficult to see the scar. Scientific studies have shown that Mederma and Vitamin E are not effective in reducing scarring. There is a small amount of scientific support for topical silicone in scar reduction.
When do I follow-up?
Follow-up/suture removal visits are typically between one and two weeks. There may be additional follow-up visits depending on the situation. Once the area is healed, you will be advised to return to your referring physician for ongoing dermatological concerns and follow-up.
What is the cost of Mohs surgery?
Most, if not all insurance companies consider Mohs surgery and the repair a covered entity. The cost varies, however, as the number of stages and the method of repair is different for every patient. Additionally, as with all procedures, most insurance companies require the member to pay a certain amount of out of pocket. Please contact our billing department to have a better idea of what your financial responsibility will be. If you are concerned about paying your portion of the medical bill, please discuss this with the billing department.
If I am concerned about how my wound is healing, what should I do?
Call us. There is always a provider on call.
How do I know if my wound is infected?
Wound infections are uncommon, but they do occasionally occur. A wound infection typically presents with increasing pain, redness, warmth, and sometimes a pus-type of drainage. If a wound is infected, the wound needs to be evaluated and antibiotics are typically prescribed. It is important to know that a certain degree of redness is normal when a wound heals. If the redness is worsening, then it could be a sign of infection.