Mohs Surgery

SUMMARY

Mohs’ Micrographic Surgery provides the greatest chance for cure for even the most complicated of skin cancers. Using this surgical technique, we are able to spare as much normal skin as possible so that we have the maximum amount of tissue for good healing. Since this procedure is carried out under local anesthesia, the risk to the patient is quite small, even in those who have other complicated illnesses. The wound healing from this surgery is usually excellent but if further cosmetic surgery is necessary, we are able to work closely with several excellent plastic surgeons in the area.

If you should have any questions or problems do not hesitate to contact Dr. Li at any time at 908-387-1001

POST OPREATIONAL CARE

This pamphlet is written to answer some of the questions that you may have after your surgery is completed. The first question always concerns wound care.

1. Sutured wounds should be kept absolutely dry for the first 24 hours

2. Clean it with hydrogen peroxide and apply antibiotic ointment daily, the wound should be covered with either bandage or gauze

3. No alcohol for 24 hours following surgery. Avoid smoking for 7-10 days after surgery

If any of the following occur - (1) severe swelling; (2) marked inflammation; (3) development of pus; (4) uncontrollable bleeding, you should contact Dr. Li at his cellphone 440-382-0421 after office hours or 908-387-1001 during office hours

(1) Will I have pain after the surgery? Most patients have little or no discomfort following surgery. If you should have some pain, we recommend that you take two tablets of Tylenol every four hours. Avoid aspirin-containing compounds or NSAID (NSAID are drugs such as ibuprofen, Naprosyn, Advil or Aleve) as they may produce bleeding. If you do have more severe pain, we will give you a prescription for the pain medicines that you will need to have filled at your local pharmacy. If your pain continues, you should contact us.

(2) What about bleeding after surgery? Most wounds will ooze a small amount of blood in the first few days. Rarely does significant bleeding occur following surgery. If it should happen, lie down and place steady firm pressure over the bandage as close as possible to the area which the blood is oozing. Apply firm, continuous pressure for 20 minutes. Do no lift the bandage to check on the bleeding. If the bleeding persists after 20 minutes of steady pressure, you should contact Dr. Li. If you are unable to reach us, go to the nearest emergency room. If the bleeding occurs in an extremity (arm or leg) elevate that extremity above the heart and apply pressure.

(3) What are other possible complications following surgery? All wounds will develop small surrounding halos of redness which will disappear gradually. Severe itching and extensive redness may indicate a reaction to the adhesive tape or the ointment that you are using. You should call the office if this develops. Swelling is common following surgery, particularly when it is performed around the eyes. All wounds show a moderate amount of swelling but usually it is not a problem. We usually insist on frequent dressing changes since all wounds will drain. If you should develop severe swelling, marked redness or purulent drainage from the wound, you should contact the office. Infrequently, wounds will become infected and it will be necessary to place the patient on an oral antibiotic.

(4) Will I have a terrible scar following my surgery? Usually the surgery wounds heal very nicely. Frequently, we are able to close the wounds with sutures, which usually give excellent cosmetic results. Other wounds are allowed to heal on their own. These too, usually heal very nicely over a period of several weeks to a couple of months. Infrequently, wounds will require plastic surgery to obtain an optimal cosmetic result. Each case is highly individualized, depending on the location of the tumor, its size, and that particular patients preference. Smoking, diabetes and certain drugs slow wound healing and may interfere with the final result. Wounds remodel themselves continuously. The most significant change in wounds occurs in the first 6-12 months.

(5) What happens if the wound is closed immediately? If the wound is closed with sutures, it will be important that you place antibiotic ointment over the suture line. Do not get the wound wet! After the first 24-48 hours, the bandage may be left off the wound. If purulent or foul-smelling drainage oozes from the wound, you should call our office. Most wounds can be gotten wet after 24 hours, but not soaking wet. Stopping smoking or a significant decrease in smoking will improve results.

(6) If the wound is allowed to heal by itself, what is the procedure? If the wound is allowed to heal by itself (granulate) the dressing must be changed every day until the wound is completely healed. All wounds normally drain and dressings are changed daily to rid the wound of such drainage and to keep the area clean. Wound care instructions will be given to you by the nurse at the end of the surgery and are repeated at the beginning of this pamphlet. Open wounds may be gotten wet after 24-48 hours.

(7) How long will it take for a wound to heal itself? Wounds which are allowed to granulate will usually heal in 4-8 weeks. When healing is advanced, you may stop the daily dressings. Wounds that are closed by sutures are healed by the time the sutures are removed at 1-2 weeks. It is important to note, however, that these wounds are still weak and could be separated if placed under any tension. All wounds will remain red and somewhat lumpy for 2-8 months following surgery.

(8) What happens after the wound is healed? You may experience a sensation of tightness (or drawing) as the wound heals, but this is normal. Some patients will develop period shooting sensations in the wound which also stop with time. After several months, you will feel less and less. Frequently, tumors involve nerves and it may take up to a year, or even two, before feeling returns to normal or near normal. Sometimes the area stays numb permanently. Only time will tell.

(9) Once the wound has healed, how often must I return for a follow up? A follow up period of observation for at least 5 years is essential after the wound has healed. Our practice is to have patients return to their referring physicians for yearly visits. Patients initially seen in our office will return here. Should there be any recurrences of the skin cancer after the surgery, it may be detected at once and treated. Experience has shown that if there is a recurrence, it usually will be within the first year following surgery. Studies have shown that once you develop a skin cancer, there is a significant possibility that you will develop others in years ahead. We recommend that you be seen at least once a year for the rest of your life by a dermatologist so that he/ she may determine whether you have developed any new skin cancers. Also, should you notice any suspicious areas on your skin, it is best to check with your referring physician to see if a biopsy is indicated.

(10) Must I avoid the sun? No, not entirely. We do not think that sunshine will be harmful to you as long as you provide yourself with adequate protection, avoid sunburn, and use discretion. As mentioned earlier, sunlight probably is the main contributing factor in the development of skin cancers and patients who have developed one skin cancer often will develop more at a later time. Therefore, in the future, when you go into the sun, we recommend that you liberally apply a sunscreen with protection factor of at least 15 to all exposed areas, including the ears. Wear a broad brim hat. Avoid mid-day sun.

WOUND CARE INSTRUCTIONS

FOR PATIENTS UNDERGOING SKIN GRAFTS

Do not pull the dressing covering the graft site, leave it alone for one week. The donor site dressing may be removed in 24 hours. This site should be treated just as the sutured wound as described earlier in the pamphlet.

After surgery, go home and sit with your feet propped up and your head elevated in a recliner, if possible. Try to remain as inactive as possible. Avoid bending over or any strenuous activity. Do not strain when going to the bathroom. The first 48-72 hours are the most critical time after surgery. Be especially careful with your activity in this time.

That night when going to bed, sleep with the head elevated on several pillows for three nights. Continue to limit your activity for 1-2 weeks following surgery. Avoid smoking for 7-10 days. No alcohol for 24 hours following surgery.

If the skin of the flap or around the flap should start to become dark blue or black, PLEASE CONTACT US.

If you develop any marked redness, tenderness, purulent drainage, or bleeding from the wound, PLEASE CONTACT US

DO NOT PULL THE TAPE OR DRESSING ACROSS THE WOUND!!!!!

Flaps are initially swollen and discolored. It takes several months for them to settle and blend with the surrounding skin. It is sometimes necessary to do a second “tune up” procedure to optimize the final functional and cosmetic result.