Pre-Mohs Instructions
Post-Mohs Instructions
Granulation Wound Care
Suture (Stiches) Wound Care
Frequently Asked Questions
How to reach Dr. Book

 

 

 

Pre-Mohs Instructions

1. Please plan to spend at least two to three hours at the office. As most of the time will be spent waiting while we study the tissue, it is helpful to have a book to read. You may bring one other person to stay with you during the wait. We request that you do not drive alone.

2. Do not take aspirin-containing medications (Alka-Seltzer, Anacin, Excedrin, Aleeve, Bufferin, Emprin Compound, Ecotrin, and many “cold pills”), for two weeks before and five days after surgery. Tylenol or acetaminophen are acceptable to take during this period. Motrin, Advil, Nuprin, ibuprofen should be discontinued five days before surgery and five days after. If you are on doctor-prescribed aspirin or Coumadin, please DO NOT discontinue.

3. The morning of surgery, eat a normal breakfast. Take any medication that you regularly take in the morning (except aspirin). Bring medication if needed during the day.

4. 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 a skirt if possible. Wear loose comfortable shoes for surgery on the feet and legs.

5. Do not apply cosmetics if the surgery is going to be done on your face.

6. Avoid strenuous exercise, bending, straining, stooping, or lifting any heavy objects for the first week after surgery if sutures have been place. Sometimes these motions can cause bleeding from one of the stitches. Arrange your schedule in advance to avoid these activities.

7. You will be given individual instructions on how to care for the wound after surgery. The type of closure will dictate what specific instructions you will need.

8. If you have taken any anti-anxiety medications before surgery you must have someone available to drive you to and from surgery.

9. If you have been given an antibiotic to take one hour before surgery be sure to take it as directed. Failure to do so may result in cancellation.

10. It is helpful to have Tylenol or acetaminophen at home prior to the date of surgery.

Post-Mohs Instructions

GENERAL WOUND CARE
You will be going home with a bulky pressure dressing. This can be removed the morning after surgery. It is fairly common for the incision to begin oozing or bleeding, especially in the first few hours after surgery. This can effectively be controlled by applying direct pressure on the bleeding site with a clean bandage and keeping constant pressure on for 15 minutes by the clock. You should also expect to have a black and blue area around the wound from surgery. The worst of the swelling and bruising will take place within 48 hours. If the surgery is on the forehead, nose or near the eyes.

If you have some discomfort following surgery, take two extra-strength Tylenol every 4 to 6 hours, but do not take aspirin or aspirin containing products (such as Alka-Seltzer, Anacin, Excedrin, Advil, Bufferin, Empirin Compound and many “cold pills”).

Rest. Avoid strenuous exercise, bending, straining or lifting any heavy objects for as long as you have stitches, usually 7 days. Sometimes these motions cam start bleeding from the incision.

If you have had facial surgery, sleep with your head elevated on two pillows; it will help to decrease any swelling that might occur after surgery. If you have had surgery on your lower or upper lip it is extremely important to eat soft foods for the first few days after surgery. Do not use a straw for 48 hours. Remove your dressing before meals – this will make eating and drinking easier for you. Ice can also be applied intermittently to the incision site. Clean the lip area and replace dressing after eating.

 

BANDAGE CHANGING INFORMATION

In about 4 weeks, some patients may develop a pimple along the stitches. If this should occur, please call the office. Your wound is not infected, but rather a buried stitch has not been absorbed by your body.

 

The Dressing should remain in place overnight. If the dressing comes loose before then, re-tape it carefully.

PAIN:
Postoperative pain is usually minimal. Extra-strength Tylenol, two tablets every four hours, usually relieves any pain you may have. You should take the extra strength Tylenol when the discomfort begins, do not wait until the pain is severe.

BLEEDING:
Careful attention has been given to your wound to prevent bleeding. You may notice a small amount of blood on the edges of the dressing the first day or so and this is NORMAL. Relax and limit your physical activity the first 48 hours after surgery. If bleeding occurs and saturates the dressing, apply firm steady pressure over the dressing with gauze for fifteen minutes by the clock. (DO NOT BE AFRAID TO APPLY FIRM PRESSURE). This usually is adequate treatment.
In the rare instance when bleeding persists, please call our office at (845) 220-2200. If it is after hours, the service will page Dr. Book.

WOUND CARE:
Your wound will be granulating (growing in) over the next several weeks. Careful and meticulous wound care will help you attain a better result.

Once a day, cleanse the wound with tap water, DO NOT use alcohol or hydrogen peroxide. DO NOT be afraid to wipe the wound carefully and cleanse away crust drainage that may be present. The wound may be tender and may bleed slightly the first day. It may seep fluid the first few days. It is normal to have a little oozing or spot bleeding everyday until the wound is healed. Your wound will heal better if all crusts and scabs are removed. For stubborn crusting, place gauze, wet with water, over the wound for 5 minutes to soak and loosen debris. Pat dry.

You may shower and allow the wound to get wet; however, do not let the forceful stream of the shower hit the wound directly.

APPEARANCE:
There may be swelling and bruising around the wound, especially if the procedure is near
your eyes. For your comfort, you may apply ice over the bandage and near the wound site
for 10 minutes every hour for about the first 48 hours. After a couple of days, your granulating wound will be light pinkish-yellow. This will lighten over the next couple of weeks and gradually become flesh colored. The edges of the wound will be pink at first and tender, fading after a couple of days. If the edges remain red and sore, the wound begins to drain puss, or if the area becomes itchy, please notify our office (845) 220-2200. The area may remain numb and be mildly itchy. You may also experience periodic pains around the wound as part of the healing process.

If you have any questions, please feel free to call us at (845) 220-2200. We want you to feel as comfortable as possible.

Wound Care Instructions (Stiches)

 

The DRESSING should remain in place overnight. If the dressing comes loose before then, re-tape it carefully.

Pain:
Post-operative pain is usually minimal. Extra-strength Tylenol, two tablets every four to six hours, usually relieves any pain you may have. Take Tylenol when pain begins – do not wait until it is severe. Do not take any aspirin, Ecotrin, Motrin, Advil, or Ibuprofen products. If the surgery is on hands, fingers, lower legs and/or feet, elevate these areas whenever at rest – this should minimize swelling and pain.

Bleeding:
Careful attention has been given to your wound to prevent bleeding. The dressing you have on is a pressure dressing and will also help to prevent bleeding. You may notice a small amount of blood on the edges of the dressing the first day and this is NORMAL. Limit physical activity for the first week after surgery. If bleeding seems persistent and saturates the dressing, apply firm steady pressure over the dressing with gauze for 15 minutes by the clock. This is usually adequate treatment. If bleeding persists please call our office at (845) 220-2200. If there is no answer, please page Dr. Book at 1-800-204-4568.

Wound Care:
The suture line should be cleaned daily with tap water. You may gently loosen these crusts with a Q-tip. Pat dry. The first day, the wound may be tender and may bleed slightly or seep a small amount of clear fluid. For stubborn crusting, place gauze, wet with tap water, over the wound for 5 minutes to soak and loosen crusting.

• Apply a layer of Polysporin ointment over the entire wound. Cover the wound with a Telfa (non-stick) dressing or a gauze pad and a piece of paper tape. It is important to keep the wound covered.
• If you have buried stitches only with Steristrips, remove gauze and tape in the morning. Then remove Steristrips after 7 days.
You may shower and allow the wound to get wet; however, do not let the forceful stream of the shower hit the wound directly. You may be given an ace wrap if the surgery is on your arms or legs. Wrap your arm or leg with the ace wrap – do not place too tightly – for 2 weeks following surgery. Keep limb elevated whenever at rest. You will return to our office in one week for suture removal.

Appearance:
There may be swelling and bruising around the wound, especially near the eyes. The area may remain numb for several weeks or even months. You may also experience periodic pains near the wound as it heals.
The suture line will be dark pink at first and the edges of the wound will be reddened. This will lighten up day by day and will be less tender. If the wound becomes increasingly inflamed, warm, drains a puss-like substance, or if you develop a fever or chills, please call our office immediately.

Now that I have had one skin cancer, am I likely to get other new ones?
Patients who have had one skin cancer have a 40% chance of developing another one over time. We therefore recommend an annual full body skin exam with your medical dermatologist.

Where is the other skin cancer likely to occur?
Basal cell skin cancer and squamous cell cancer occur most commonly on the face, head, and neck although they can occur at other sites, too. Melanoma, the most potentially lethal form of skin cancer, can occur anywhere and you should be aware of the warning signs.

What are the warning signs?
For basal cell cancer and squamous cell cancer, any pimple that does not heal after a few weeks, or a growth that begins to bleed should be examined promptly. A patch of redness, scaling or irritation that persists should also be evaluated by your dermatologist.

The warning signs of melanoma include: any change in the color, shape or size of a mole; a mole that itches or begins to bleed or crust; or a new mole that appears unusual. These should be evaluated immediately. Remember that most melanomas are virtually completely curable in the earliest stages if diagnosed and treated promptly.

What are the chances that the cancer that has been removed by the Mohs surgery will come back?
Your chances of complete cure are excellent. However, no technique is perfect. You underwent Mohs surgery because of the need to obtain the highest cure rate. In general there is a 95% to 99% cure rate. However, if your cancer has been previously treated or was very large, the cure rate is somewhat lower and careful follow-up is a must.

Since skin cancer is related to sun exposure, do I now have to stay out of the sun completely?
Most skin cancers result from sun exposure over a lifetime, so moderation with respect to sun exposure continues to be the best policy. In our region, sunscreen should be used when you go outdoors on sunny days. If you sunburn easily, a sunscreen with SPF 15 or higher should be applied. If you’re especially active or spend time in the water, the sunscreen should be reapplied frequently. You may also use a water resistant sunscreen. If you do not burn easily or tend to have a darker complexion you should still use SPF 15 sunscreen. Sunscreens are considered safe and important to use in children.

Is there anything else I can do to minimize my risk of getting other skin cancer?
While it has not been proven that you can halt much of the damage that has already been initiated (skin cancers take several years to develop), following simple guidelines will help you prevent further sun damage, and perhaps reduce the chance of getting other cancers. Avoid the sun between the peak hours of 10 A.M. and 3 P.M. Wear a broad brimmed hat. When outdoors for lengthy periods, such as on a boat or playing golf, wear clothing with a tight weave. Clothes only supply a sunscreen factor of 4; therefore it is advisable to use sunscreen under your clothes. Do not sunbathe. Do not use tanning parlors.

How often should I be checked out for skin cancer?
Dermatologists have different opinions on this and you should be guided by your dermatologist.

Because you have already had one skin cancer, an annual full body skin examination is recommended by most dermatologists.

After you’re discharged from our care, be certain to follow-up with the doctor who referred you to us so that he or she may examine you for any new signs of skin cancer.

How often will I have to come back to the office after my surgery?
Your first visit to our office will be in 5 to 7 days to have your sutures (top layer of stitches) removed. In cases where it is difficult for you to return to our office, absorbable sutures will be used or arrangements can be made for your local physician to remove the sutures. After sutures are removed you will follow-up with your referring physician. For granulating wounds, (wounds that are allowed to heal on their own), the return visit will vary. In general we will see you one to four weeks after surgery.

Who will coordinate my post-operative visits?
You will see the surgical nurses or Dr. Book. The RN's have been certified in advanced dermatologic surgery practice and will help you in your post-operative care. They and your doctor are always available to answer questions or to see you if you have concerns about how healing is progressing.

What is going to happen to my scar?
Complete healing of the skin takes time. Whether you had plastic reconstructive surgery or allowed the wound to heal on its own, patience is essential. The healing process continues in the skin for a full year. Sometimes, areas of hard scar tissue develop in the first six months after surgery but these soften and mature with time. If you had a flap or skin graft, the final result can only be judged nine to twelve months after the surgery. Occasionally, it is necessary to inject the scar with a type of hydrocortisone to reduce excessive scar tissue. To help soften the scar, you may massage the area daily for ten to twenty minutes using a lubricant such as petrolatum. This is best accomplished by applying a small amount of the ointment over the hard or raised part of the scar and massaging firmly in a circular motion. Many people prefer to use Vitamin E cream. There is no evidence this will help healing but you may use it if you like. In addition, the Curad Scar Therapy Cosmetic Pad, which can be found in the bandage section of many drugstores, may be used to help speed the natural healing process.

UNDISSOLVED SUTURES
Early on, about four weeks after the surgery, some of the dissolving stitches placed under the surface of the skin may not dissolve completely, and may form a small pimple. The stitch is trying to push its way out and is behaving like grass pushing up through pavement. This is not dangerous but you should give us a call if this happens so that we may see you to remove it.

Occasionally superficial skin nerves are cut during surgery, which results in localized numbness or loss of sensation to a small area around the surgery site. The nerves will grow back but the time for this to happen will vary. In addition to numbness, as the healing process proceeds you may feel tingling and/or itching. This may last 6 months or more after surgery, but everyone is different and the duration of these symptoms can vary markedly among individuals.

Will there be changes in skin color associated with the surgery?
Often, during the early stages of healing, the scar will be red or pink because of the temporary growth of the new blood vessels. These will fade with time, but until they do, unsightly redness can be concealed with make-up. In addition, if the redness does not resolve as expected, methods are available to improve it.

Remember: If you have any questions about your surgery, do not hesitate to call. If we are unavailable at the time, please leave your name and number with our receptionist and we will return your call as soon as possible.

 

 

 

 

Contact Dr. Book in an Emergency

Office Phone Number:
(845) 220-2200