Can I eat breakfast before surgery?
Yes. Since you will not be sedated, there is no need to fast. In fact, low blood sugar can be problem in diabetics who do not eat breakfast. Please eat normal meals and arrive 15 minutes early.
Should I take my normal medications on the day of surgery?
Unless otherwise instructed by our office, continue all of your prescription medications. Aspirin should be continued in any patient taking it for known cardiovascular (stent, bypass) or cerebrovascular (stoke, TIA) disease. Patients taking aspirin purely for prevention should stop for at least 10 days prior to surgery. Other pain medications which can increase bleeding include ibuprofen (Advil, Motrin) and naproxen (Aleve). Acetaminophen (Tylenol) does not increase bleeding and may be taken any time before or after surgery unless other contraindications exist. If you are taking warfarin (Coumadin), please notify our office before your scheduled surgery date as we will need to confirm your INR blood test is 3.0 or less within 1 week prior to the procedure. Alcohol will also increase bleeding so please avoid alcoholic beverages for at least 24 hours before surgery.
May I come alone on the day of surgery?
We suggest that you arrange to have a companion drive you to and from the clinic on the day of your surgery. You may also be more comfortable with someone to keep you company in the waiting room.
Do I really need surgery?
Biopsy wounds often heal very well. Regardless of how fast or how well the biopsy site has healed, further surgery is indicated when the pathology report indicates residual tumor cells, when the intent of the initial procedure was only to biopsy (not remove), or when the standard of care requires an extra margin of tissue be taken to reduce the risk of recurrence or metastasis.
Will I be sedated?
No. Sedation is not performed at this office. It is normal to have some anxiety prior to surgery. Most of this anxiety is due to fear of pain, which is why we strive to provide "painless" local anesthesia. Once nervous patients are numbed, their anxiety usually subsides. Rare cases are not suitable for office-based surgery. Those cases are referred to hospital-based surgeons, usually Head & Neck Surgeons.
How often does infection occur?
The rate of wound infection following Mohs surgery at this office in 2011 was <1%, which compares favorably to the national average. The rate of infection following simple biopsy procedures is also less than 1%. A small amount of redness and a yellow (fibrinous) wound bed are normal parts of healing and do not mean infection. Patients may always have their wound evaluated by the provider when there is question.
Will I have a scar?
Yes. Any procedure that removes skin will create scar tissue. The type of procedure, site of procedure, individual skin type and scarring tendency, quality of wound care, and occurrence of complications all contribute to the severity of scarring. Once a scar has formed, it will mature and improve spontaneously for up to 18 months. Thick (hypertrophic) scars may be treat by steroid injections. Keloids are a much more rare and serious type of scarring caused by genetics.
For skin cancer, Mohs surgery removes as little normal tissue as possible, thereby minimizing scarring. After the cancer is removed we may choose to: (1) let the wound heal by itself, (2) close the wound with stitches, (3) reconstruct the wound with a skin graft or flap, or (4) reconstruct the wound on another day. This decision is based on the safest method that will provide the least noticeable scar.
What's the difference between biopsy and pathology?
A biopsy is a procedure that takes a sample of skin or other tissue. The most common types of biopsy in dermatology are shave biopsies and punch biopsies. The doctor or provider that performs the biopsy procedure will bill you and/or your insurance the amount set by your insurance company. "Pathology" refers to the techinical service performed by the lab that does the processing and slide preparation, as well as the professional service performed by the pathologist or other qualified physician who looks at the slides under the microcope. The entity that performs the service (technical or professional) will bill you and/or our insurance the amounts set by your insurance company.