What Happens At The Preoperative (Consultation) Visit?

The preoperative visit gives the physician an opportunity to examine your skin cancer, take a pertinent history and determine whether the technique of Mohs micrographic surgery is the most suitable way of treating your skin cancer. Also, it gives you, the patient, the opportunity to learn about the procedure.

At the time of the preoperative visit we need to know about your medications, allergies, and any current medial problems. Also, we need to know if you have any artificial joints, pacemakers, heart valves, or cardioverters.

Every skin cancer is different, and because of the length of the treatment, careful scheduling is necessary. A suitable date of surgery that is mutually acceptable will be arranged for as early a time as possible.

When the patient has been referred to us, usually the skin biopsy (removal of a piece of tissue) have been performed, and we have the pathology report that states what type of skin cancer is present. If we do not have this information, we may perform a biopsy at the initial visit.

Because not all skin cancers are alike, we need to know exactly what type you have before we can decide which method of treatment is best suited for your particular or individual case. All patients are photographed before and after surgery, and after healing. These photographs become part of your medical record and may be used for teaching or research purposes.


What Happens On The Day Of Surgery?

Appointments for surgery are usually scheduled early in the day. This allows us to continue the surgical steps throughout the entire day, if necessary.

The nurse will escort you to an operating room where a physician or nurse will inject a local anesthetic, usually Xylocaine, around the skin cancer to numb the skin and prevent discomfort during surgery. Be sure to inform the surgeon if you do experience any pain. Also, if you have had any previous problems with local anesthetics, be sure to let us know.

The next step is for the surgeon to remove a thin layer of tissue involved by the cancer. After this tissue has been carefully removed, bleeding is stopped with a machine called a cautery (or "Bovie"). We will put your hand on a metal plate so that the cautery works better. You may feel a slight amount of heat in the wound. Before you leave the operating room, the nurse will apply a bandage to your wound, and, by the time you get to the waiting room, the removed tissue will be in the laboratory where it is prepared for microscopic examination.

The most difficult part of the procedure is waiting for the results of the surgery. It usually takes between one to two hours to prepare the slides, although sometimes it make take somewhat longer. While you are waiting, you may go out to eat. No alcoholic beverages, please. Alcohol dilates blood vessales and may promote bleeding.

If examination of the slides reveals that your tissue still contains skin cancer cells, the procedure will be repeated as soon as possible. Several surgical excisions and microscopic examinations may have to be done in one day, and seldom is it necessary to have a patient return the following day for adidtional surgery.


How Many Stages (Sessions) Of Mohs Micrographic Surgery Will I Need?
This depends entirely upon how deep or extensive your skin cancer is. Unfortunately, there is no way to determine this prior to surgery. A schematic drawing of three stages (sessions) to remove a skin cancer is shown below. On average, skin cancer requires two to three stages for complete removal.
© Richard G. Bennett, M.D. 2003