Surgical Skin Care Instructions
Click on the links below for instructions on how to care for your skin after your surgical procedure.
• Instructions for Cryosurgery (liquid nitrogen freezing) aftercare
• Skin Biopsy Post-Procedure Care Instructions
• Surgical Pre-Operative Information
• Surgical Post Operative Instructions (for surgery requiring sutures)
• Surgical Post Operative Instructions (for surgery not requiring sutures)
• Post Operative Wound Care Instructions (Skin Grafts)
• Instructions for After Cortisone Injection to a Cyst
• Instructions for After Incision and Drainage of a Cyst / Abscess

Skin Cancer Treatment
Many different options are available for the treatment of basal cell and squamous cell skin cancer. The following factors are used by our physicians to determine the most appropriate method for any individual patient: the type of cancer, its location, size, distinctiveness of the tumor margins, whether any previous treatments have been attempted, and the patient's general health and desires. Treatments for skin cancer include the following:

• Curettage and electrodessication ("scrape and burn") is a shallow method appropriate for small skin cancers of the trunk and extremities.  However, the cure rate is not as high as with other surgical treatments and therefore this approach is not used for large skin cancers, aggressive subtypes, cancers in high-risk areas such as the face, ears, scalp, or neck, and cancers in areas where cosmetically unacceptable scars may result.  Scarring can be very noticeable with this method as the wound is left open to heal and is not sutured.

• Surgical excision is the removal of skin cancer by cutting through the full thickness of the skin with wide margins followed by wound closure with sutures.  It allows some sampling of the margins to assess whether if it is likely that the cancer has been removed.  However, because complete margin testing is not possible, the cure rate is not as high as with Mohs micrographic surgery.  Also, a relatively wide margin needs to be excised, increasing the amount of skin that is removed, and therefore the size of the scar.

• Topical creams such as 5-flurouracil and imiquimod have shown some success in treating superficial skin cancers of the trunk.  However, the cure rates are generally lower than with other treatments and intense inflammation and swelling over a period of several weeks can make completing the treatment course difficult.  Nevertheless, this may be a good treatment option for small lesions in patients who do not want surgery or are not good candidates for surgery.

• Radiation therapy is another option for patients who are poor surgical candidates.  The downside is that radiation treatment usually requires five treatments per week for several weeks at a hospital so it can be very time consuming.  Side effects include painful inflammation, skin ulcers and unsightly scars.  Radiation also can sometimes leave patients feeling tired and exhausted during the treatment period.  Ironically, radiation therapy itself can be the cause of skin cancers years later. Still, in selected patients this may be the most appropriate method.

• Mohs Micrographic Surgery is considered the gold standard of skin cancer treatment. It offers the highest cure rate possible and removes the least amount of tissue, meaning that the scar is usually smaller than with other surgical methods.  However, Mohs surgery is not necessary for many small, simple skin cancers on the trunk, arms, and legs, as this approach usually requires more time and expense than some of the simpler treatments.

Mohs Micrographic Surgery
Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer.  Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all "roots" and extension of the cancer can be eliminated.  Due to the methodical manner in which tissue is excised, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.  Mohs surgery provides the most precise method for removal of the cancerous tissue, while sparing the greatest amount of healthy skin.  For this reason, the Mohs method may result in a significantly smaller surgical defect and less noticeable scarring as compared to other methods of skin cancer treatment.  Mohs micrographic surgery is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes (e.g., eyes, ears, lips, nose, hands, genitals).  It is also indicated for lesions with ill-defined borders, lesions that have recurred after prior treatment, and lesions that are considered to be at high risk of recurrence.

During the Mohs procedure, your skin cancer site will be sterilized and numbed using a local anesthetic.  The skin surgeon then removes a thin layer of the malignant growth, checking this layer under the microscope for the presence of tumor while you wait.  Depending on what is seen under the microscope, an additional layer may be cut out and then examined microscopically.  This way the tumor can be mapped out and traced to its roots.  Often times, the growth, if small and not possessing large extensions, will be completely removed in the first or second "harvesting" of tissue.  Sometimes, multiple rounds of tumor removal are done until clear margins are obtained, meaning the cancer is completely removed in all directions and the reconstruction process can begin.

Mohs Surgery Pre-operative Instructions
If you are on prescription medications, continue them unless otherwise instructed by your doctor.  Inform us if you are taking any blood pressure medications, or blood thinners such as Coumadin, Plavix, aspirin, ibuprofen (Motrin, Advil), or other aspirin-like medicines.  You may take Tylenol (acetaminophen) for aches and pains.
           
Inform us if you have: artificial joints or valves, pacemaker, any bleeding disorder, or any problems with your immune system. If you have an artificial heart valve or an artificial joint, you may require oral antibiotics prior to your procedure.  Check with your medical doctor prior to your surgery.
           
Do not take any of the following 7-10 days prior to surgery as they increase the chance of bleeding: alcohol, vitamin E, ginkgo, ginger, ephedra, garlic, and fish oil.
           
It is essential for proper wound healing that you DO NOT SMOKE for at least one week before and for at least two weeks after your surgery.
           
Avoid heavy lifting as well as strenuous exercise for two weeks after your surgery. Do not submerge the wound (avoid baths, hot tubs, saunas, ocean or swimming pool) until sutures are removed.
           
Shower the morning of your surgery. Wear a button down shirt or blouse if the surgery is on the face or head. For surgery on legs wear pants with loose fitting legs or shorts if possible. Do not apply cosmetics if the surgery is going to be done on your face.
           
Please get good night's sleep and eat normally the morning of your surgery.  Expect to be with us for most of the morning.  Please bring a light snack and a book or magazine to keep you occupied while you wait for pathology results after each layer of skin cancer is removed.  Free Wi-Fi is also available in our office.
           
You can drive yourself since there will be no general anesthesia or sedating medications used, however it may be nicer to have a friend or family member accompany you. We will ask anyone accompanying you to wait in our waiting room while your procedure is being performed.

Options for Reconstruction after Mohs Surgery
After the skin cancer is completely removed, your doctor will discuss with you:

• Allowing the wound to heal naturally on its own - no further surgery or stitches.
• Re-arranging normal skin from other areas surrounding the cancer to repair the wound (graft, flap, or complex closure).
• Referral to a plastic surgeon for wound repair.

 The best course of action can only be decided once the cancer is removed and the final wound is evaluated.  If a wound can be closed from side to side without adversely affecting the nearby anatomy, this may be the best course of action.  For some wounds, the skin cannot be stretched enough, the repair will require skin adjacent to the surgical defect to be partially cut free and rotated or moved forward to cover the surgical defect (called a flap).  Alternatively, skin from a hidden area can be removed and placed over the wound (called a graft).  Stitches (sutures) are placed to hold either flaps or grafts in place.  You will be given instructions for how to care for the wound during the healing process and when to return for suture removal.

Wound Healing, Scarring, and Scar Revision
 As with any surgery, there will be a scar associated with Mohs surgical removal of skin cancer.  Mohs surgery will however leave the smallest possible surgical defect and scar.  Scars can take up to one year to mature to their final appearance.  There are many techniques to improve the appearance of scars.  The cosmetic aspects of the wound can be addressed with you in detail during follow up appointments.

Potential Side Effects and Complications
 It is important to know that no procedure can absolutely guarantee total removal of every cancer cell.  Recurrence is always a possibility.  However, recurrence rates are lowest with Mohs surgery.  There is always a risk of bleeding, infection, and abnormal healing.  Additionally, during surgery, small nerve endings are cut, which may result in temporary or permanent numbness in and around the area of surgery.  With larger or deeper tumors, nerves controlling movement of muscles could be cut which may result in permanent weakness in a portion of the face.  Fortunately, this is a very rare complication.  There may be some minor swelling, itching, or pain in the surgical area.  Additional surgery may be needed if poor healing takes place.  Your doctor will be with you for every step to assure smooth healing and recovery.

Mohs Surgery Post-Operative Instructions
Supplies you can purchase in a drug store:

• Telfa (non-stick or non-adherent) pads
• Paper tape
• Vaseline ointment or honey gel which may be purchased in our office
• Cotton tipped applicators (Q-tips)
• Gauze pads

For your convenience we also have wound care kits for sale, consisting of Telfa pads and paper tape.

 For the first 24 hours after surgery, do not get the wound wet and keep the dressing as it is. After 24 hours you may take a shower (remove bandage prior to shower, water may gently run over wound). Pat the area dry gently using a clean soft cloth or gauze.

DAILY DRESSING CARE:

1. Always wash your hands prior to dressing changes.
2. Carefully remove the previous bandage.
3. Apply recommended topical (Vaseline ointment or honey gel) generously to the wound with a cotton tipped applicator to keep the surgical site moist. (Neosporin ointment is not recommended as it has a high allergy rate).
4. Cover wound with a Telfa pad cut to cover the size of the wound (if there is significant oozing you may also apply gauze pads on top of the Telfa.
5. Secure Telfa dressing in place with paper tape.

THINGS TO DO:
• Take Tylenol (acetaminophen) for any discomfort, if necessary.
• Continue Coumadin (Warfarin), aspirin, or any other blood thinners you have been prescribed by your doctor.
• If any bleeding should occur, elevate the wound site higher than your heart and apply 20 minutes direct pressure without peeking. If the situation persists, please call us immediately.
• Swelling and bruising are fairly common and should start to subside 3-4 days following your surgery. It may take 2-3 weeks for these symptoms to completely subside. If the wound is on your face, scalp, or neck, it may be helpful to sleep with your head elevated on 2 pillows; for wounds on the extremities, legs and arms should
be kept above the level of the heart whenever possible.
• If you were prescribed an antibiotic or pain medication, please take as directed.
• Call our office immediately if you develop any of the following symptoms of infection: increasing redness, increased pain, increased swelling, warmth, fever, and a cloudy discharge from the wound.
• Return for suture removal in 7-14 days as directed.  At that time you may start using scar healing products as directed by your provider.

THINGS TO AVOID:
• Avoid Aspirin, Aleve, Motrin & Ibuprofen
• Avoid alcohol for 5 days post operatively
• Avoid smoking as this hinders the wound healing process.
• Avoid any strenuous exercise or activity (bending, lifting heavy objects that could be harmful to the wound) for at least 3 weeks.
• Avoid lying or sleeping on the side where surgery was performed.
• Do not submerge the wound (avoid baths, hot tubs, saunas, ocean or swimming pool) until sutures are removed. 

If you have any questions or should need to reach the doctor, please call the office at 310-802-8180. Follow the voice mail prompts if you need to leave an after-hours urgent message.

---

About Us | Our Staff | Medical Services | Cosmetic Procedures | Specials | Skincare Products
Skin Surgery | Forms | Patient Portal | Office Policies | Contact Us | Location and Hours