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Edmonton's Cosmetic Surgery Clinic
How do patients prepare for the day of surgery?
The best preparation for Mohs surgery is a good night's rest followed by breakfast. In most cases, the surgery will be completed on an outpatient basis in our clinic. Because you can expect to be here for most of the day, it is wise to bring a book or magazine to read. Also, because the day may prove to be quite tiring, it is advisable to have someone accompany you on the day of surgery to provide companionship and to drive you home.
We request that you stop taking any aspirin or aspirin-containing compounds and Ibuprofen (Advil) two weeks before your surgery. This is because they may interfere with the normal blood clotting mechanism, making you bleed more than normal during surgery. If your physician has prescribed these medications, please check with him/her before making any changes. If you have questions about specific medications you are taking, please call our nurses.
What happens the day of surgery?
Mohs surgery appointments are purposely scheduled early in the day. Upon arrival the patients check in at the Western Canada Dermatology Institute Surgical Unit reception desk. When the surgical suite is available, the patients are escorted by the surgical nurse to the treatment area. She goes over the procedure and answers any questions. Dr. Sapijaszko is also available to answer questions.
The patients are placed on the surgical table and the area around your skin cancer is cleansed and anesthetized (numbed) using a local anesthetic. This may be uncomfortable, but usually this is the only pain one feels during the procedure. Once the area is numbed, a layer of tissue is removed and the bleeding controlled. The layer of tissue removed is then carefully handled by Dr. Sapijaszko, diagrammed, and sent to the technician to be processed into microscopic slides. A dressing is placed over your surgical wound and the patients are allowed to rest. On the average, it takes 30 to 60 minutes for the slides to be prepared and studied. During this time the patient can relax or read the book or magazine.
Most Mohs surgery cases are completed in two or three stages. Each stage involves the removal and microscopic examination of your skin for cancer. Therefore, the majority of cases are finished during one day. Once Dr. Sapijaszko is sure that he totally removed the skin cancer, the determination is made as to the best method to deal with the resulting surgical wound.
What can I expect after the surgery is completed?
Dressings
Once the surgery is completed, your wound will be dressed with special dressings. Depending on the size of the wound, its location and the type of repair used, the dressing can be quite substantial. Dr. Sapijaszko or his staff will go over wound care instruction with you and provide you with a written handout. Follow-up appointment will be made to remove the stitches or change dressings.
Pain
Most people are concerned about pain. With our technique, most patients experience remarkably little discomfort during or after the surgery. Following surgery, most patients can benefit from Tylenol or Extra Strength for the fist day or so. After that the discomfort is usually minimal. In rare cases, Dr. Sapijaszko can prescribe a stronger pain reliever.
Bleeding
A small number of patients will experience some bleeding post-operatively. This bleeding can usually be controlled by the use of pressure. Patients can take a gauze pad and apply constant pressure over the bleeding point for 15 minutes without lifting up or relieve the pressure at all during that period of time. If bleeding persists after continued pressure for 15 minutes, repeat the pressure for another 15 minutes. If this fails, patients are asked to call our office or visit a local Emergency Room. It is advisable not to drink alcohol the first post-operative night as this may stimulate bleeding.
Complications
There are some minor complications that may occur after Mohs surgery. A small red area may develop surrounding the wound. This is normal and does not necessarily indicate infection. However, if this redness persists or worsens in two days or the wound begins to drain pus, patients should notify Dr. Sapijaszko and/or his team immediately. Itching and redness around the wound, especially in areas where adhesive tape has been applied, are not uncommon. Swelling and bruising are very common following Mohs surgery, particularly when it is performed around the eyes. This usually subsides within 5-7 days after surgery and may be decreased by the use of ice packs in the first 48 hours. At times, the area surrounding the operative site will be numb to the touch. This area of anesthesia (numbness) may persist for several months or longer. In some instances, it may be permanent. If this occurs, please discuss it with Dr. Sapijaszko at the follow-up visit.
Although every effort will be made to offer the best possible cosmetic result, patients are left with a scar. The scar can be minimized by the proper care of the wound. Dr. Sapijaszko and his team discusses wound care in detail with patients and give all patients written Wound Care Information Sheets that explicitly outlines how to take care of whatever type of wound patients have.
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