Mohs Microscopic Surgery - Dr. Patrick Walsh

Surgery for removal of a skin cancer can be a very stressful experience. To reduce stress and make your experience more relaxed there are a number of things you can do:

• Leave enough time to travel; take traffic and weather into account on the day of surgery.

• Read and follow your pre-operative instructions. Call the office with questions prior to surgery. Being prepared and informed will greatly reduce stress levels.

• If you have questions for Dr. Walsh, write them down and bring them to your appointment. Often patient’s forget important information when they are under stress.

• Try to have a good night sleep prior to surgery and eat breakfast before you leave for your appointment.

• Wear appropriate clothing for your surgery. For example, if your skin cancer is on the chest, you may be more comfortable in a button front shirt. Our office may be chilly at times so bring something warm to wear.

• Be prepared to be at the office for 2-6 hours depending on your skin cancer site and how many stages of Mohs surgery you will undergo. It is possible you may be discharged earlier but being prepared for an all day appointment will greatly reduce stress levels. Do not make other appointments for your day of surgery.

• Verify your insurance coverage before your surgery date. If you are unsure regarding insurance coverage for your surgery, you may call our office or your insurance carrier.

Day of Surgery

When you arrive at the office on your surgery day, the nurse will take you back to your surgery room and the following procedures will be followed:

• The nurse will check your blood pressure and record any recent changes in medication or medical history.
  
  
• Dr. Walsh will mark out the surgical site and take pictures for your medical records.
  
  
• The nurse will place a grounding pad on your arm for the use of a cautery; a small cautery pencil helps us to stop any bleeding that may occur during the surgery.
  
  
• You will be placed in a reclined position on the chair.
  
  
• The nurse will anesthetize your surgical site. Ice will be used to numb the area and reduce the initial stick and stinging sensation of the needle.
  
  
• During this time, you will be asked to repeat your name and date of birth, changes in medical history or medications and verify the area to be operated on. This is part of our “time out” procedure to ensure patient safety.
  
  
• Dr. Walsh will surgically remove the biopsy site or scar and any tissue that looks suspicious for “Stage One” of your Mohs Surgery procedure. The area will be cauterized, a pressure bandage applied and you will be asked to proceed to the waiting area.
  
  
• Your wait time for tissue processing will be approximately an hour. The office provides coffee and cookies/crackers but you may wish to bring additional snacks and reading material.
  
  
• The tissue is taken to the laboratory, frozen and fixed onto slides which allow Dr. Walsh to view and determine if your tissue has positive or negative margins.
  
  
• When your slides are processed, you will be taken back to your surgery room. If your tissue has positive margins, “Stage Two” of your Mohs surgery procedure will be performed. You will be required to wait for the slides to be processed. The same procedure will continue until tissue examination reveals negative margins.
  
  
• If your tissue has negative margins, Dr. Walsh will discuss options regarding the healing process of your surgical site.
  
  
• You will be required to return to the office for a dressing change or suture removal in 7-14 days and again in 3 months for follow up.

Questions or concerns regarding your surgical site will be addressed by the nurse. If you have an urgent question after hours which cannot wait until the next working day, you may call the office and follow instructions to leave a message. A staff member will call you back as soon as possible.