The Patient’s Experience

It is our hope that you will feel confident and well cared for during every step of your experience with us, from your first contact with our knowledgeable and friendly front office personnel to the care of our experienced and caring nursing staff. Dr. West and his entire team are dedicated to providing you excellent care and an enjoyable, positive experience.

As a Mohs Patient you can anticipate the following steps in your care:

1. Preoperative Consultation
2. Day of Surgery
3. Post-Operative Course
4. Long-Term Course — After the Wound Has Healed

The Preoperative Consultation

The preoperative visit gives Dr. West an opportunity to examine your skin cancer, take a pertinent history and confirm that Mohs surgery is the most suitable treatment for you. Also, it gives you the opportunity to meet Dr. West and his staff, to learn more about the procedure and to ask any questions you may have. Your surgery will then be scheduled for the earliest possible date. If your skin cancer has not been biopsied previously, a biopsy will usually be performed, as well.

The Day of Surgery

You can expect to be in our office 3-4 hours, however, you should arrange to be available for the rest of the day.
Surgery is nearly always finished the same day, unless the tumor is extensive or a highly complex repair is required.
While the length of time required for Mohs surgery is initially surprising and perplexing to some patients, the
following description of the process generally alleviates such concerns.

First, a local anesthetic is used to numb the skin around the tumor to prevent discomfort during surgery. Light
sedation is rarely required, but is available for those who feel anxious. When the skin is numb, Dr. West then removes
a layer of tissue involved by the cancer, bleeding is stopped with electrocoagulation, and a dressing is applied. The
procedure to this point typically requires 10-15 minutes.

The removed tissue is immediately taken to the laboratory where it is prepared for microscopic examination.
Laboratory preparation and examination under the microscope are delicate procedures and require great precision.
They are also time-consuming; usually an hour to an hour-and-a-half is required for each layer or stage. On average,
two to four stages are required to completely remove a tumor.

The most difficult part of the procedure for you will be waiting for the results of the microscopic examination. You
may want to bring a pillow if needed for back support, and a sweater or blanket (we keep the temperature on the cool
side). Be sure to wear comfortable clothing and to bring reading material, paper work, word puzzles or other activities
to help pass the time. You are welcome to bring one friend or relative to accompany you while sitting in the waiting
room, however, patients are discouraged from bringing more than one guest due to limited seating capacity. Snacks
and drinks are usually available in the office, however, if you desire, you may bring a lunch. It is preferred that
patients stay in the office until their surgery is completed. If for some reason you must leave the office, it is very
important that you first check with a nurse and leave a number where you can be reached.

Once the skin cancer is completely removed, Dr. West will discuss with you the options for management of the
surgical wound. Usually there are three choices:

1. Let the wound heal by itself; this usually takes 4 to 8 weeks.
2. Close the wound with stitches.
3. Cover the wound with a skin flap or graft.

Dr. West will recommend which of these choices will be best in your case. If it is determined that the wound should be
repaired, this is usually performed by Dr. West the same day. In unusual cases, a plastic surgeon may be consulted to
perform the repair.

The Post-Operative Course

It is seldom necessary to have someone drive you home after surgery, but it may be convenient if you tend to tire easily. Since you will probably be fatigued you should plan on taking it easy and getting plenty of rest the first night. Most patients do not complain of pain. Two Tylenol tablets (total 1,000 mg acetaminophen) taken every 4-6 hours are usually sufficient to relieve the discomfort some patients experience the first 12 to 24 hours. Swelling and bruising are very common, particularly when surgery is performed on the nose or around the eyes, and generally resolve within a week to ten days. Painless red, purple or yellow bruising and swelling of the eyelids often appear 2-3 days after surgery on the forehead, and are no cause for concern. The use of extra pillows the first 4 nights following surgery to keep the head and shoulders elevated while sleeping can help minimize this.

Very occasionally there is continued bleeding following surgery. If this occurs, lie down, remove all of the bandages, and with gauze, apply firm, steady pressure for 20 minutes (timed) over the area of the wound that is oozing blood. Do not lift the gauze to check on the bleeding before 20 minutes have passed. If bleeding persists after 20 minutes of steady pressure, immediately notify our office or go to the nearest hospital or emergency room.

All wounds normally develop a small halo of redness around them which gradually disappears. If increasing redness, warmth, tenderness or pain develop, or if you see foul-smelling fluid or pus draining from the wound, call our office immediately. The wound may have become infected and an antibiotic may be necessary. If the skin around the wound becomes very itchy and red, you are probably having a reaction to the adhesive tape or to the antibiotic ointment used to dress the wound. You should call our office if this occurs.

The Long-Term Course — After the Wound Has Healed

Some patients may experience uncomfortable sensations of tightness, numbness, tingling, sensitivity to temperature change,or itching at the surgical site. These sensations are normal and tend to improve with time over several months. Gently massaging the site several times each day can speed the process, however, this should not be done until at least 6 weeks after surgery. Itching may be due to dryness and can be improved with plain Vaseline. Redness at the site is also normal and will gradually fade, usually by 6 months.

A follow-up period of observation at intervals for at least 10 years is essential. One out of two patients with their first skin cancer will develop another within five years. Therefore, patients should be seen for examination every 3-4 months for one year, then annually. This way any new or recurrent skin cancers may be detected and treated in their early stages. If you were referred by another dermatologist, this follow-up should be performed by them. Be sure to report immediately any suspicious lesions you notice on your skin to see if a biopsy is necessary.