Before Your Visit: Mohs Skin Cancer Surgery

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1 Befre Yur Visit: Mhs Skin Cancer Surgery Yur Kaiser Permanente Care Instructins Skin Cancer Infrmatin What is skin cancer? Skin cancers are tumrs, r malignancies, f the skin. Skin cancer is assciated with increasing age and increased sun expsure, hwever many patients wh develp skin cancer are quite yung and have had minimal sun expsure. The tw cmmn types f skin cancer are: Basal cell carcinma (mst cmmn) Squamus cell carcinma Hw is skin cancer treated? There are several different methds available fr treating skin cancer, including excisinal surgery, radiatin therapy, curettage cmbined with electrical burning (ED&C), freezing (crysurgery), and tpical treatments such as imiquimd (Aldara). Smetimes these methds are unsuccessful because the skin cancer has an extensive rt system, similar t the rts f a tree. What causes f skin cancer? The causes f skin cancer are nt cmpletely knwn. There are, hwever, several risk factrs that increase a persn s risk f skin cancer. Risk Factrs fr Skin Cancer: Previus histry f skin cancer Older in age Spending a lt f time in the sun ver many years Histry f blistering sunburns Fair skin Light hair r eye clr Use f sterids r ther medicatins that suppress the immune system Histry f radiatin expsure Hw des skin cancer begin? Skin cancer starts grwing in the tp layers f the skin and grws dwn, frming rts t the tissues belw the skin. Skin cancer can spread hrizntally alng the surface f the skin. These rts cannt be seen directly. What is seen n the surface f the skin may be nly the tip f the iceberg. Is skin cancer dangerus? The cmmn skin cancers: Basal cell carcinmas can enlarge but almst never spread (metastasize) t ther parts f the bdy. Treatment is almst always successful. Squamus cell carcinmas can spread, but usually slwly s that they are nt very dangerus. If the skin cancer is nt cmpletely remved, bth basal cell carcinma and squamus cell carcinma can grw and destry structures in their path. Cmpared t ther frms f skin cancer, these types f skin cancer are generally recgnized in the early stages and are mre easily cured. Other frms f skin cancer may als be treated with Mhs Surgery.

2 Mhs Surgery What is Mhs Surgery? The gal is ttal remval f skin cancer and t nly remve the diseased tissue. Steps f Mhs surgery: 1. The area is numbed using a lcal anesthetic. 2. The dctr remves the visible skin cancer and a small amunt f tissue arund the tumr. 3. The remved tissue is marked t tell the tp frm bttm and right frm left. 4. The remved tissue is examined by the dctr fr skin cancer. 5. If any f the edges f remved tissue cntain skin cancer, the dctr remves anther thin layer f tissue. Tissue is nly remved frm the area where skin cancer cells were seen. 6. The dctr examines the newly remved tissue fr additinal cancer cells. 7. If the dctr still sees skin cancer, the steps repeat until the cancer is cmpletely remved. Hw many runds f skin cancer remval will I need during Mhs surgery? If skin cancer cells are seen at the edge f the remved tissue, there is mre skin cancer that must be remved. The benefit f Mhs surgery is that the dctr will remve nly the areas f tissue where there is skin cancer. This will help yu keep as much f yur nrmal tissue as pssible. Abut half f all tumrs require nly ne remval. Half f all tumrs will need multiple tissue remvals during yur Mhs surgery. What are the advantages f Mhs surgery? Lcates skin cancer and selectively remves nly thse areas. Skin cancer rts are remved. As much nrmal tissue as pssible is kept. 97% t 99% success rate, even if ther frms f treatment have failed. Excellent chance f curing the skin cancer. Less waiting time fr results than ther skin cancer surgery. Why shuld I try Mhs surgery when ther surgery has nt wrked? Other methds t treat the skin cancer may nt have wrked because it did nt destry all f the skin cancer cells. Mhs surgery finds the rts f the cancer and cures almst all patients. Preparing fr Mhs Surgery Pre-perative Visits Fr mst, the pre-perative visit is part f yur Mhs surgery appintment. Smetimes a pre-perative visit is needed by the surgen r by yur referring dctr. If fr any reasn yu need a pre-perative visit r yur referring dctr needs a visit, we will schedule an appintment fr yu. Tw weeks befre surgery: If yu have a histry f heart attack, cardivascular disease, irregular heartbeat, strke, r TIAs (mini-strke) and if yu are taking Cumadin, Plavix (Clpidgrel), and/r Aspirin cntinue taking as prescribed. If yu d nt have a histry f heart attack r strke and yu are taking Aspirin fr preventin stp taking all aspirin and aspirin cntaining prducts.

3 Stp taking all herbal medicatins that may thin yur bld (see Medicatin Precautins handut). Never discntinue any prescriptin medicatin until yu have checked with yur dctr. If yur skin cancer is n yur face, place ntify us if yu use a CPAP machine at night. Arrange fr smene t drive yu hme frm surgery. We encurage all patients t have a ride but, yu need t have smene drive yu hme frm the prcedure if: Yur skin cancer is lcated very clse t the eye. Yu are anxius and wuld like medicatin t help t relax yu during yur surgery. A few days befre surgery: If yu becme ill (have a cld, fever, r think yu have been expsed t illness (and might becme sick) please call yur surgen. Cnfirm yur driver. The night befre surgery: Try t get a gd night s rest! Wash yur hair if yur skin cancer is n yur scalp. Yu will nt be able t wash yur hair fr a few days after surgery. The mrning f surgery: Eat a light breakfast, unless therwise directed. Take yur medicatins as usual unless therwise directed by yur dctr (see Medicatin Precautins handut). D NOT wear make-up r jewelry. D NOT shave the area arund yur skin cancer. Wear cmfrtable and lse fitting clthes. Please bring the fllwing items t yur surgery appintment: Pht ID and Kaiser Permanente ID card If yu have a pacemaker r defibrillatr: yu are required t bring yur device infrmatin card t surgery. If yu d nt have a card, please call Cardilgy at t get ne. CPAP mask, if yu wear a CPAP and yur skin cancer is n yur face. A bk r magazine. The prcedure may take a full day. Yu will spend part f the time in the waiting rm while yur tissue is examined. The Day f Surgery Please arrive 15 minutes early fr yur Surgery appintment at the Kaiser Permanente Arapahe Medical Office. Address: 5555 E Arapahe Rd, Centennial, Clrad Yu will check in at the main check-in desk and then will g dwnstairs t the Mhs Surgery clinic. After yu check in, a surgical assistant will bring yu t the surgery area. They will ask yu a few questins and check yur vital signs. The assistant will als prepare yur skin fr surgery. Yur surgen will check-in with yu and see if yu have any questins. Remving the skin cancer Yu will be given a lcal anesthetic befre yur surgen remves the skin cancer. After the tissue has been remved, a machine is used t stp the bleeding. This machine generates heat and it might feel warm. The surgical assistant will cver yur wund with a bandage and yur tissue will be sent t the lab fr examinatin by yur surgen. While yu are waiting fr results:

4 It will take 1 t 2 hurs t lk at the tissue. While yu are waiting, yu will relax in the waiting rm. A friend r family member can g t the cafeteria t pick up a snack fr yu if needed. It s imprtant t stay in the waiting area during this time. Same Day Results: If the lab sees skin cancer n yur remved tissue, the prcedure will be repeated as sn as pssible. Several tissue remval and tissue lab exams may be dne in ne day. Mst peple d nt have t return the fllwing day fr additinal surgery. Mst peple need 2 r 3 remval prcedures and have their entire skin cancer remved by mid-day. This is an utpatient surgery. Mst peple are able t g hme the same day. It is rare yu wuld need t stay in the hspital vernight. The Surgical Wund There are 3 ways t treat the wund after surgery: Clsing the wund directly with stitches (sutures) Letting the wuld heal by itself (granulatin) Clsing the wund with a skin graft r flap Yur dctr will recmmend the best treatment fr yu. Treating the wund after surgery will be dne by yur surgen. Rarely, in special situatins we will plan ahead fr ther surgical specialists t repair yur wund. Each patient is different and we will chse the treatment that will wrk best fr yu. Healing: Yu may be asked t buy the Mhs dressing kit frm the Kaiser Permanente pharmacy. Yu will get specific instructins n hw t care fr yur wund at hme. Yu will need t rest fr at least 2 days, pssibly lnger, after surgery. Yu may nt exercise r lift heavy items fr at least 2 days. Yu will have a large bandage ver the surgery area fr at least 2 days. During the first few days r weeks, it is nrmal t feel tightness as yur surgery wund heals. Yu will feel this less and less. Smetimes, skin cancers may spread t invlve nerves and it may be ne r tw years befre yur sensatin returns t nrmal. In sme cases, the numbness may be permanent. If yur wund is itchy, a thin layer f petrleum jelly may help t relieve the itch. Scarring: Any frm f skin surgery will always leave a scar. Mhs surgery decreases this as much as pssible. We make every effrt t get the best csmetic result fr yu. The new skin that grws ver the wund can have many mre bld vessels than the skin that was remved. This causes a red scar that can be sensitive. Redness and sensitivity will decrease ver time. Yur wund will heal fr 1 year after surgery and will lk better during this time. Fllw-Up Care After Surgery After yur Mhs surgery, yu will cme in fr regular check-ups fr 3 years. Studies shw that if the skin cancer is ging t cme back, it will within the first few years. Als, if yu have had skin cancer nce, yu are at an increased risk fr getting skin cancer again. Check with yur dermatlgist n hw ften yu shuld have skin checks. If yu ntice any suspicius areas, signs, r symptms f skin cancer it is best t check with yur dermatlgist t see if further testing is needed.

5 Sun Expsure: The sun shines brightly here in Clrad! While yu shuld nt spend the rest f yur life in the dark, we knw the sun is a big factr in the develpment f many skin cancers. It is imprtant that yu prtect yur skin frm the sun: Apply sunscreen (SPF f 30 r mre) every day t all expsed areas f yur skin. This includes yur face, ears, hands, and any ther areas. Reapply sunscreen every 2 hurs! Wear a brad-brimmed hat and clthing that will cver yur skin. Yes, yu may lead a nrmal lifestyle if yu take precautins! Where can I learn mre abut skin cancer? G t kp.rg and type skin cancer in the search bx.

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