Before, During and After
An initial pre-operative visit is necessary to thoroughly examine your skin cancer, answer your questions, review your medical history, and determine the most beneficial and effective treatment plan. When patients are referred to us, a biopsy of the lesion has usually been performed, and the pathology report stating the exact type of skin cancer is available. If a biopsy has not been performed, it may be done at this visit.
Please bring a list of your doctors with their addresses and phone numbers to your pre-operative visit, so we may keep them informed of your treatment and progress. Additionally, please bring a list of your current medications, including any over-the-counter medications, vitamins, and herbal supplements.
We suggest that you arrange to have a companion drive you home the day of your surgery. We find it helpful if this person accompanies you the day of the pre-operative visit.
Prior to Mohs Surgery
You may continue to take your usual medications, unless otherwise instructed. It is advised that you discontinue any alcoholic beverages for 7 days prior to surgery, as alcohol may increase bleeding during and after your procedure. Additionally, it is recommended that you decrease or stop any tobacco products 7 days prior to surgery, as these products impede the wound healing process and may result in a less than optimal cosmetic result.
Please notify our office with any changes to your health or medication regimen that may have occurred since your initial visit with Dr. Martinelli or Dr. Russell.
The Day of Mohs Surgery
The best preparation for surgery is to be well rested and eat a good breakfast the morning of surgery. If you take regularly scheduled medication in the morning, please take it prior to your visit, unless otherwise instructed.
Surgery is usually scheduled early in the day, and you can expect to be here most of the morning, and occasionally, most of the day. We would like the time you spend with us to be as pleasant as possible, so you may want to bring a magazine, book, and/or snack, and we suggest you wear comfortable loose-fitting clothes. Beverages, reading materials, and Wi-Fi access are available in the office.
The actual Mohs process includes a specific sequence of surgery and pathological inspection. It is performed in our outpatient surgical center utilizing local anesthesia and sterile technique. Although you are awake for the entire procedure, discomfort is minimal and usually no greater than that experienced at the time of your biopsy. After the area is completely numb, the procedure is as follows:
- The obvious tumor is removed by scraping (curettage).
- A thin layer of additional tissue is then taken around and under this area.
- A temporary bandage is then placed over the wound.
- The removed tissue is taken to our lab, cut into sections, stained, and marked on a detailed diagram (Mohs map), which is used as a guide in order to map out the precise location of any remaining cancer cells.
- The tissue is then frozen in a cryostat, and the histotechnician cuts thin slices from the undersurface and edges of the specimen and places them on a glass slide for microscopic examination. This is the most time-consuming portion of the procedure, often requiring one hour or more to complete. You may spend this time in the comfort of our waiting room with the person who accompanied you.
- Dr. Martinelli and Dr. Russell then carefully examine the tissue under the microscope for their patients, assessing 100% of the entire peripheral and deep surgical margins.
- If any residual cancer is found, it is carefully marked on the Mohs map and an additional thin layer of tissue is removed from the involved area only. This tissue undergoes the same processing and evaluation as described above.
- When microscopic examination reveals that there is no remaining cancer in the surgical site, the surgical wound is then ready for repair (reconstruction).
The most aesthetically pleasing type of repair will be determined based on the size, depth, and anatomic location of the resulting wound. Some reconstructive options include:
- Natural healing (granulation) - for small wounds and/or wounds in certain locations;
- Stitches (primary side-to-side closure);
- Skin graft - movement of healthy skin from another location to cover the wound;
- Skin flap - movement of nearby adjacent skin to cover the wound; or
- Reconstruction by another physician, who specializes in complicated surgical repairs.
Dr. Martinelli and Dr. Russell contact all of their patients on the evening of their surgery and provide them with their personal mobile phone numbers to ensure 24-hour direct access.
It is important to remember that it may take up to one year after surgery for a scar to look its best. You will return to our office for follow-up appointments during your early post-operative period to ensure that you are healing appropriately. After that time, you will be followed by your referring physician for continued surveillance and skin care.