1. What is skin cancer?
Cancer is a tissue, which grows at an uncontrollable and unpredictable rate, There are three main forms of skin cancer: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.
2. Is it dangerous?
The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. These types typically do not spread to distant parts of the body. If not completely removed, they can invade and destroy structures in their path of growth.
3. What causes skin cancer?
Excessive exposure to sunlight is the most important factor associated with the development of skin cancers, which appear most commonly on the face and arms. Other possible factors contributing to the development of skin cancer includes x-rays, trauma, and certain chemicals.
4. How does skin cancer start?
Skin cancer begins in the upper-most layer of the skin and grows downward and along the surface of the skin. What is apparent to the naked eye on the surface of the skin may only be the “tip of the iceberg”.
5. How is it removed?
Using Mohs Micrographic Surgery, your cancer will be removed as follows: (1) After the area has been numbed, the visible portion of the cancer or the area of the biopsy will be removed with a thin layer of normal appearing tissue around the area; (2) the edge and base of the tissue will be examined under a microscope. If any remaining cancer cells are seen, the surgeon will go back and take more tissue in the area the cancer was seen.
6. How long does it take?
Removal of skin cancer depends on how wide or deep it may be growing and the flow of the laboratory. After the surgery, a decision is made as to the best way to manage the wound created by the surgery. This will be discussed later. This process may take the whole day.
7. How effective is Mohs’ Micrographic Surgery?
Using the Mohs technique, the percentage of success can be as high as 979a to 99% for basal cell carcinoma and almost as high for squamous cell carcinomas. There is no other treatment with this success rate.
8. What are the advantages of Mohs’ Micrographic Surgery?
Besides the high cure rate, this technique allows the physician to pinpoint areas of cancer and selectively remove those areas. Thus, the surgeon tries to minimize the amount of tissue removed while still removing the cancer.
9. Will the surgery leave a scar?
Yes. However we make an effort to obtain an optimal cosmetic result for the patient and may work in conjunction with another reconstructive surgeon if necessary.
10. How much does the surgery cost will my insurance pay?
Mohs surgery is outpatient surgery. Medicare accepts almost all out total charge and will reimburse you 80% of their accepted charge. If you have a second insurance policy or co-insurance this should pay the major portion of the remaining bill. For those who do not have Medicare, the amount that your policy will pay toward the cost of the surgery varies with the type of policy you have. If you have any questions concerning this you can call your insurance company. We will be glad to help file your insurance claims; however, the patient will be responsible for any balance not covered by insurance.
11. How should I prepare myself for Mohs’ Micrographic Surgery?
Eat a good breakfast. If you are taking any medications, take them as usual unless we direct otherwise. If you take warfarin (“coumadin”) please notify our office at (801) 965-2799. We will ask you to have your warfarin level (“INR” or “Protime”) checked shortly before surgery Do not discontinue any blood thinners prescribed by your physician. If you take aspirin for preventative reason only (you have never had a heart attack, blood clot or stroke), please discontinue the aspirin 2 weeks before surgery. Also discontinue supplements that can thin blood: Vitamin E, Fish Oil, Feverfew, Gingko Biloba, Ginseng, Ginger, or Garlic. Moreover, please do not drink any alcohol for two days before or after surgery.
12. How long does the surgery take?
Each step of the surgical procedure takes about 10-30 minutes. Following surgery, it might take over one hour for the slides to be prepared for microscopic examination. Several surgical stages and microscopic examinations may be required. We recommend you bring a book or something else to keep you occupied while waiting. You may want to bring food or many in case you are here past lunch and would like to buy food during one of the waiting periods.
13. Should someone come with me on the day of surgery?
Yes. Please have someone accompany you or plan to drop you off and pick you up. We ask that you limit the number of people accompanying you to one or two people because of limited space in our waiting room. No small children please.
14. Is there pain associated with the surgery?
A local anesthetic (typically lidocaine) will be used, to numb the skin around the cancer. Please inform us if you experience anything more than slight discomfort. It in understandable to be nervous about this procedure and we are happy to prescribe a medication that can be taken the night before and the day of surgery, This medicine can relax you but might make you drowsy so you definitely need a driver if you choose to take the medicine. Please inform us prior to surgery if you are interested in having us order you some medication.
15. What happens the day of surgery?
The area will be anesthetized and then Dr. Hinckley will remove the area of the cancer as previously described. It usually takes 15 to 30 minutes to anesthetize the involved area and to remove the tissue. The removed tissue will be sent to the laboratory for processing. It will take 1 to 2 hours to prepare the tissue for microscopic examination and examine the slide. While you are waiting, you are free to leave the area for refreshments, just alert us first. If the tissue removed still contains cancer cells, the procedure will be repeated. You will be photographed before treatment as well as after surgery and again after healing. These photographs become part of your medical record and may be used for teaching purposes.
16. What happens after the cancer has been removed?
When we have determined that the skin cancer has been completely removed, a decision is made on what to do with the wound created by the surgery. We will involve you with the decision-making. Usually we will close the wound with stitches but sometimes we may choose to let the wound heal by itself.
17. What happens during the wound healing process?
Frequently, tumors involve nerves and it may take up to one year or even two, before feeling returns to normal or near normal. Sometimes the area stays numb permanently. the new skin that grows over the wound contains many more blood vessels than the skin that was removes. This results in a red scar and the area may be sensitive to temperature changes. This sensitivity improves with time and redness gradually fades.
18. Later on must I avoid the sun?
No. Provide yourself with adequate protection, avoid burning, and use direction. Each morning, apply a liberal amount of a lotion containing sunscreen with a SPF of 15-30 or greater to exposed areas of the face, neck, scalp and ears.