Please be aware thatyou may need someone to driveyou homeafter your Mohs surgery depending on the location of the surgery (near the eye) or if you receive anti-anxiety medications to help your day go smoother. Most patients are scheduled directly for surgery without a preoperative visit. Your provider will have reviewed your pertinent medical history including pathology reports before your surgery and a consultation will be done on the day of the procedure. It is important that you read all the information that we have provided andfill out the Health Questionnaire before your appointment.If you would like to see your provider in consultation prior to the surgery date, we will gladly schedule you an appointment. Please plan accordingly as you will be subject to activity restriction following your surgery. It is recommended you do not participate in athletic activities for 7-10 days following surgery. Mohs surgery is performed under local anesthesia using injections; you will not be put to sleep. Wesuggest that you eat your normalbreakfastor lunch unless otherwise specified.Takeall of your normal medications on the day of surgery, unless instructed to do otherwise. Please bathe or shower and wash your hair to minimize your risk of a surgical site infection. If needed, we will provide you with an anti-anxiety medicine once you have signed the consent form. You will need someone to accompany you to give you a ride home. This is a requirement if you receive anti-anxiety medicine. Many of our patients are on blood thinners that are prescribed by their physician. We do not recommend stopping them without explicit permission from the prescribing physician. If your prescribing physician has given you guidelines for stopping blood thinning medicines for a few days prior to minor procedures (surgery or dental procedures), check with your physician and follow those guidelines. For those on Coumadin/Warfarin ,please make sure that your INR is in the therapeutic range and please have your most recent INR available for your provider. We request that you stop taking any prophylactic aspirin or ibuprofen compounds (like Anacin, Bufferin, Advil or Motrin), alcohol, vitamin E, ginko biloba and garlic pills at least 10 days before your surgery. They can increase your risk of bleeding during surgery. If your physician has instructed you to take aspirin for any reason other than routine prevention, please do not discontinue without their permission. Finally, get a good night’s sleep the night before surgery. On the Day of Mohs Surgery When you arrive and first see your provider on the day of Mohs surgery,you will need to positivelyidentifythe biopsy site on which surgery will be performed. The surgical assistant will review your history and prepare the lesion for Mohs surgery. This is a great time to ask the surgical assistant any questions you might have. Your provider will review your case and come in to mark the surgery site in surgical ink. You will be asked to sign consent that you understand the possible risks of surgery (bleeding, pain, infection, recurrence, numbness, scar) and not doing surgery (cancer grows/spreads). The surgical assistant will numb the area with a local anesthetic and prep the area for surgery, which includes getting you comfortable, cleansing the surgical area with antiseptic and placing towels around the operative site. Your provider will then carefully debulk an obvious remaining tumor and remove a layer of tissue. Any bleeding will be controlled using a cautery or bipolar forceps and the surgical assistant will bandage your surgical site. Your provider will take the layer of tissue to the laboratory where it is mapped by orienting it with nicks and tissue dye in preparation for processing. Your provider's histotechnician will then process the outer margin of tissue, making microscope slides of this true margin. These slides are stained with hematoxylin and eosin or special stains so that your provider can carefully examine the microscope slides for any remaining cancer at the margin. This processing takes approximately one hour and is repeated when the microscope slides show residual cancer at any margin. Typically patients are in our office for 3-4 hours, but longer cases do occur when tumors are very large or have ill-defined margins. You will spend a significant time in the “Mohs waiting room” during your appointment while tissue is processing. It is a good idea to bring something to read or work on for the day of surgery. To make your stay more comfortable, we have a television and wireless Internet access . You are welcome to bring a friend or family member to your surgery appointment to accompany you while you wait in the Mohs waiting room,but please limit the number of people accompanyingyou to one person due to the limited space in our waiting room. If you have several family members or friends at your appointment, we may ask you to wait in a designated area within our building at the Hulston Cancer Center. What to Expect After Surgery
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