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Male Voice: Skin cancers are extremely common on the face, eyelids, and neck. Most of these cancers are best treated by surgical removal. When working in areas where tissue is extremely important to spare, we often combine services with a surgeon trained specially to remove skin cancers, in conjunction with a plastic surgeon who has the skill to repair the defects. The idea of removing skin cancers using two surgeons is that the cancer can be removed in its entirety while still creating the smallest possible defect, which will then allow delicate anatomical structures to be spared.

In a typical scenario, you would present first to the Mohs surgeon's office. Under local anesthesia, they would remove the skin cancer, checking under the microscope to make sure that the cancer is removed in its entirety, again, while making the smallest possible defect. Once it has been determined that the cancer has been removed in its entirety by examination of the tissue that's been removed, under a microscope, the Mohs surgeon will place a patch over your eye, and you'll either come to our office, or go directly to a surgery center. I will see you before surgery. The idea is always to perform an operation which is going to give the best functional and cosmetic result.

Very commonly after Mohs surgery repairs, a patch will be placed over the treated eye and you can remove that at home the following day. The amount of surgery that's required will of course depend on the size of the defect which is created. In some situations, we even have to do a 2-step procedure, where, for example, an eyelid may be sewn shut, or a flap may be moved from the forehead or the cheek, which, we'll need to come back and do a second stage procedure on, several weeks or months later. I'll try to give you an idea, if that will be the case, before surgery, but sometimes I don't know until I'm actually in the operating room, what procedures going to be required to ultimately give you the best functional and cosmetic effect.

Before undergoing any surgical procedure on the eyelids or face, if possible, it's very helpful to discontinue the use of aspirin, Motrin, Advil, ibuprofen, or other blood thinners. Our office will supply you with a long list of drugs that thin the blood so you can make certain that you're not taking anything which you should avoid. It's very important to remember that if a doctor has prescribed those medications for you ahead of time, you can't just discontinue the use of the drug of your own accord. We'll need to get permission from the doctor who prescribed the medication, to make sure it's safe to discontinue it.

The day of surgery, someone will need to drive you to and from surgery. In most cases, when the repair is performed, we'll give you some medication in an I.V., so that you're sleepy and don't have any discomfort. In some situations, we'll even use general anesthesia. The duration of time required for the repair will, of course, depend on how much work needs to be done.

After surgery, someone will, of course, need to drive you home. You may have some discomfort. I usually encourage patients to take extra strength Tylenol for pain, and in most cases, that's sufficient. You will be provided with prescription pain medication, but the prescription pain medication often will make people sick to their stomach, and unless I've done so much surgery that I think you'll need it, I usually suggest using Tylenol. Again, it's important not to use aspirin, Motrin, Advil, or other blood thinners for pain after surgery.

After the Mohs surgery procedure has been completed, and the repair been performed, you've gone home, hopefully you've had a good night's sleep, the next day you remove the patch, if there's one been placed. The stitches that are placed in the skin may need to be removed by our office staff when you've returned, or may be self-dissolving. It just depends on the type of repair that's been performed.

Once the patch has been removed, which you'll do at home, the day after surgery, you'll use cold compresses on a regular basis for the first 24-48 hours, to help reduce bruising and swelling. And you'll also antibiotic ointment to the stitches on a regular basis. It's important that you not let the stitches dry out.

Surgical Treatment for Skin Cancer

Doctor Brian Biesman discusses surgical treatment for skin cancer.

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