Friday, April 12, 2024

Recovery From Mohs Surgery On Lower Leg

Reconstruction After Mohs Surgery

Mohs Surgery: Arm, Feet and Trunk Care

In some cases, wounds from Mohs surgery can be extensive and may require the assistance of another surgeon. We will help you find a SLUCare physician or a physician close to your home who can perform these procedures.

There may also be times when your personal physician refers you to SLUCare for Mohs surgery with a plan to perform reconstructive surgery for you shortly afterwards. A delay between your Mohs surgery with us and reconstructive surgery with another doctor may not be convenient, but it will not cause ill effects. It is often necessary as the Mohs surgery may require most of the day.

Following reconstruction, we will provide you with further written instructions for the care of your wound, along with verbal explanations from the doctor or nurse and phone numbers in case of questions.

What Are The Risks

Mohs surgery is generally considered very safe, but there are some risks:

  • Bleeding from the site of surgery
  • Bleeding into the wound from surrounding tissue
  • Pain or tenderness in the area where skin was removed

Although these are less likely to happen, there are other potential problems:

  • You could have temporary or permanent numbness in the area where the skin was removed.
  • If your tumor was large and your surgeon cut a muscle nerve while removing it, you might feel some weakness in that part of your body.
  • You might feel itching or shooting pain.
  • You could develop a thick, raised scar.

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Tips For A Speedy Recovery

  • Follow any post procedure advice given by your provider
  • Attend all scheduled follow-up visits
  • Refrain from touching or scratching the treatment area
  • Do not apply makeup until cleared to do so by your physician
  • Avoid exercise or vigorous activity until cleared by your physician
  • Stay properly hydrated by drinking lots of water
  • Sleep with your head elevated on an extra pillow if Mohs was performed on your face or neck
  • Avoid sun exposure and practice sun protection following the procedure

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Is Mohs Surgery Covered Under Most Insurance

Mohs surgery is the gold standard for treating skin cancer on the head, neck, hands and feet. For most insurance plans, Mohs surgery is covered for these areas, as well as on the trunk and extremities for more aggressive skin cancers.

Compared to other skin cancer treatments like wide local excision and radiation therapy, Mohs surgery is a cost-effective way to treat skin cancer. Mohs surgery also has an extremely low cancer recurrence rate, reducing the chance you’d need an additional procedure.

Surgical removal, tissue processing and tissue reading are all done by the Mohs surgeon. In other types of skin surgery, you might need an anesthesiologist, a surgeon and a pathologist all charging their own services.

Can Mohs Surgery Cause Nerve Damage

Pin on MOHs

With any skin surgery, there are potential areas where nerve damage could occur. Anytime we consider surgery, we counsel our patients that there are tiny sensory nerves in the skin. Often those sensory nerves are impacted. The good news is, many of those sensory nerves regenerate over time.

In the majority of skin cancer surgery, there is no motor nerve involvement. Motor nerves are nerves that move muscles. Depending on where the skin cancer is, how deep it is and how aggressive it is, sometimes the cancer can involve motor nerves. If there’s any risk of affecting motor nerves, we discuss the expected outcomes before surgery begins. If the cancer does involve a motor nerve, it can sometimes regenerate. Other times we can use surgical and non-surgical modalities to help the body compensate.

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What Are The Advantages Of Having Mohs Surgery

The most important advantages of Mohs surgery are the complete microscopic examination, which allows for complete removal of the cancer and high cure rates, and the ability to spare as much normal skin as possible.

Additional advantages of Mohs surgery for skin cancer include:

  • Its done in a single outpatient visit.
  • Youll receive local anesthesia to numb the area, so youll recover faster compared to general anesthesia or sedation.

What Happens Before Mohs Surgery

Before you have a Mohs surgery for skin cancer, youll see your dermatologist for a physical exam of the site and surrounding tissue. Together, you and your dermatologist will review:

  • Your medical history and any medications or supplements you take.
  • The results from your biopsy.
  • Your diagnosis of skin cancer, including your treatment options and the risks and benefits of Mohs surgery.

Depending on your general health and the location of the surgical site, you may need to take preoperative antibiotics.

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Healing After Skin Cancer Surgery

You should plan on wearing a bandage for 10-14 days. Please plan to avoid strenuous physical activity for 48 hours, and in some cases one week.

You may experience a sensation of tightness across the area of your surgery. Skin cancers frequently involve small superficial nerves, and months may pass before your skin sensation returns to normal. A numbness sensation may be expected over the area. This is common and usually expected but is something that with time will return to normal. In very rare instances, the numbness may be permanent.

Mohs Surgery Post-Op InstructionsPost-Op Surgery Instructions Skin Grafts

Complete healing of the scar takes place over 3-12 months. Especially during the first few months, the site may feel thick, swollen or lumpy, and there may be some redness. Gentle massage of the area will speed the healing process.

The defect created by the removal of the skin cancer may be larger than anticipated. There is no way to predict prior to surgery the exact size of the final defect.

There will be a scar at the site of removal. We will make every effort to obtain optimal cosmetic results, but our primary goal is to remove the entire tumor. Again, Mohs surgery will leave you with the smallest wound, thus creating the best opportunity for optimal cosmetic results.

Answer: Squamous Removal After Biopsy

Postoperative Care for Mohs Surgery

Thank you for your question. There is typically no reason to wait to have surgery after a biopsy is performed and a tissue diagnosis has been made, unless there are other complications such as infection that might compromise a surgical procedure and closure. Options for removal are variable, depending on the size of the tumor, and are best determined by either a Board Certified Dermatologist or Mohs surgeon. Issues and specifics of wound closure and scarring are also dependent upon tissue availability and tumor size. These again, are best made by a professional, after examination of the patient. I hope this helps.

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Can You Drive Home After A Mohs Procedure

For most patients, it is safe to drive home after the operation. Local anesthesia does not cause drowsiness, and the surgical wound is not expected to restrict body movement.

Still, if this is a concern, you may discuss it with your surgeon before you get discharged. At BHSkin Dermatology, patient safety is our top priority. Our doctors will give you a quick, thorough check before clearing you for driving and sending you home.

What Is The Purpose Of Mohs Surgery

Mohs surgery is a painstaking procedure. It requires microscopic analysis of tissue cells while the surgery is taking place. The borders of each thin layer of tissue are analyzed for potential malignancy as they are removed horizontally. This technique is designed to remove the entire tumor with minimal amounts of healthy tissue. This results in less disfigurement. For this reason, Mohs surgery is ideal for removing skin cancers from the face, ears, or genitals.

The procedure is highly effective for skin cancers that have high rates of recurrence. Its also effective on aggressive or large lesions. Mohs surgery is also used when lesions have ill-defined borders.

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Answer: Squamous Cell Removal From Lower Leg

It’s not necessary to wait for the initial wound to heal before performing the excision, so it’s not necessary to wait 7-8 weeks, but it is also OK to do this if that’s what your physician’s schedule permits maybe. I very much doubt you would need a Mohs in this case because Mohs is only required for skin cancer removals where you need to preserve the most tissue you can, such as the face, nose, ears, sometimes hands or feet. It’s not necessary to do Mohs on the back, torso, arms, legs, etc. in most cases because there is more than enough tissue to cut a safe amount of skin out, and then suture the area closed. Two layers of sutures is just fine and there is much more skin there than you realize. Two layers allows the area to remain closed better, and it’s common in almost any procedure like that to do two layers of sutures. One stays under the skin and dissolves and the other is on the top and then those are removed. Follow your doctor’s post care instructions to minimize scarring, but you should expect redness, and most likely a small straight scar.

What Are Treatment Options For Skin Cancers

Scalp Flap Skin Graft Alternative Cases

There are many effective ways to treat skin cancers. Options include local radiation treatments, curettage and desiccation “C& D” , cryosurgery , photodynamic therapy using Levulan and laser and or blue light, regular surgical excision, laser removal and surgery, Mohs surgery, and several prescription creams, including imiquimod and fluorouracil .

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How Can I Take Care Of Myself While Im Healing From Mohs Surgery

Following Mohs surgery, youll want to take care of yourself to allow for optimal healing. Your surgeon will give you instructions for aftercare following Mohs surgery. When you go home, youll have a dressing on your wound. Leave it undisturbed for the first 24 to 48 hours, or as directed by your surgeon. After that initial period of healing, remove the dressing for wound care two times a day or as directed. To care for your wound, cleanse with 3% hydrogen peroxide or a mild soap, then cover your wound with petroleum jelly and cover it with a dressing that wont stick to your wound. Once the dressing is no longer needed, be sure to protect your scar using sunscreen with a sun protection factor of at least 30, as well as protective hats during any sun exposure.

Your surgeon will also instruct you to:

  • Avoid strenuous exercise and heavy lifting for at least a week.
  • Apply ice or cold packs regularly in the days following surgery to reduce swelling and bruising just be sure not to put the ice directly on your skin.

How long should I use Vaseline® after Mohs surgery?

You should cover your wound with petroleum jelly at least until your sutures are removed . At this follow-up visit, your surgeon will take a look at the area to see how your wound is healing. They may instruct you to use petroleum jelly for another couple of weeks.

What Kind Of Physician Can Perform Mohs Surgery Where Can I Find A Doctor Board

Most Mohs surgeons are specially trained dermatologists. There are also some plastic surgery and ear, nose, and throat surgeons who are also trained to perform Mohs.

There is no current board certification for Mohs surgery. There are two nationally recognized MMS specialty groups, the American College of Mohs Micrographic Surgery and Cutaneous Oncology and the American Society for Mohs Surgery.

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Are You Awake For Mohs Surgery

Yes, most people are awake for Mohs surgery. Your surgeon will numb the area with injected medications . You will feel pressure and touch but no pain, and youll rest comfortably in the waiting room or in the operating room while they analyze your tissue. If you need more skin removed, you may still be numb from the initial injections, or more injections may be needed.

What if Im anxious about surgery?

Its quite common to feel anxious before a procedure. Your healthcare provider may recommend a variety of techniques to calm your nerves. During the procedure, you may want to listen to music or a guided meditation. Your provider may also give you antianxiety medication before the procedure.

What Areas Are Treatable By Mohs Surgery

Mohs Surgery: What to Expect

Although any skin site is amenable to MMS, it is used primarily for the treatment of head and neck basal cell carcinomas and squamous cell carcinomas . It is particularly useful for skin cancers in difficult areas such as nose, lips, and ears, where it is important to remove a minimal amount of uninvolved tissue.

It is also useful on hands and feet in order to minimize scarring. MMS is very effective for the treatment of recurrent tumors . However, depending on the specific patient and tumor type, any area of the body may be treated by Mohs surgery.

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How Much Pain Is There After Mohs Surgery

Most patients report mild to moderate pain following Mohs surgery. The pain goes away gradually over a few days and can be effectively managed with acetaminophen . Individuals who have Mohs surgery on their scalp or whose wound is larger than 3 square centimeters tend to report more pain than those who have the procedure on other areas.

Mohs Surgery Vs Excision: Whats The Difference

Excision is a procedure through which your surgeon removes the skin cancer and a margin of surrounding skin and the specimen is sent to pathology for processing and interpretation. In general, less than 1% of the margins are checked with wide local excision. . Mohs micrographic surgery involves excision with a smaller margin and the tissue is processed in such a way that your surgeon checks 100% of the deep and side margins.

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Answer: Do Not Swim Until Sutures Are Removed

Wounds on the lower leg are typically under a great deal of tension. In addition, pool water can harbor bacteria . To maximize the cosmesis of your wound, refrain from any exercise until your stitches are removed. Remember, at the end of one month, your wound is only 40% of its original strength. Good luck, Dr. Mariwalla

Can The Cancer Come Back

Pin on Patient Outcomes

Mohs surgery has the highest cure rate of all treatments for basal cell and squamous cell carcinomas — more than 99% for new skin cancers and 95% if the cancer comes back.

Your doctor will want to schedule regular follow-ups with you to check your skin for new cancers. Twice a year is normal, but you may need them more often if the cancer is an aggressive type thatâs more likely to come back. You and your doctor will decide on the right schedule.

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What Can You Expect When Undergoing Mohs Surgery

At the start of the procedure, the Mohs surgeon will mark the incision site, clean it and inject local anesthesia. Once the site is numb, the doctor will scrape off the bulk of the tumor then cut out the first layer of cancerous tissue.

The removed tissue will then be frozen and examined microscopically. The surgeon will check its edges for the presence of cancer cells and map out the remainder of the tumor. More tissue will be excised until no more malignant cells are found. A thin, cancer-free margin is also taken out.

Removing the cancerous tissue and closing up the surgical wound are quick. However, the entire session can take hours because of the freezing process and microscopic examination. You may use your gadget, read magazines, etc. while waiting. Patients generally leave an entire day open when scheduled for Mohs surgery. Some tumors may even require stage-wise removal, which can take a few sessions.

Lower Extremity Infection Following Mohs Micrographic Surgery

Dermatologic Surgery

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    What Is Mohs Surgery

    Mohs micrographic surgery, or simply Mohs surgery, is a technique that entails cutting away at a skin tumor serially in thin layers until it is totally removed. It is usually performed by a dermatologist specially trained in this method. It is the gold standard of treatment for non-melanoma skin cancer because of its advantages.

    • The Mohs procedure has the highest cure rates compared to wide excision and other forms of skin cancer treatment.
    • It is the most cost-effective therapy for non-melanoma skin cancer.
    • The Mohs technique preserves the greatest volume of healthy skin. Therefore, it is best for lesions on the eyelids, nose, lips, ears, fingers, toes, and genital areasites where tissue-sparing is crucial to cosmesis or function.

    About 80% of patients who undergo Mohs surgery have basal cell carcinoma, while 20% have squamous cell carcinoma. Both malignancies are less aggressive than melanoma, so they respond better to this minimally invasive approach. However, its use in melanoma management has also increased over the last few years because of cure rates reaching 98%.

    Watching For Signs Of Infection

    Mohs Surgery – Full Procedure | McFarland Clinic

    Infection is one of the most significant concerns immediately after skin cancer removal. Patients need to be instructed to watch for indications such as:

    • Expansion of redness around the surgical wound. Red splotches or threads suggest infection may be spreading.
    • Clear drainage may be noticed from the surgical wound, but colored or cloudy drainage is concerning and needs to be evaluated.
    • Enlarged lymph nodes near the area of surgery.
    • Worsening pain.

    Scarring is a secondary concern and one that can be managed with conventional remedies. As the Mohs wound heals, patients should avoid sun exposure as much as possible. A silicone dressing may be applied as directed to keep the healing tissue moist. Mohs surgeons sometimes carry products they know to have good quality, taking the guesswork out of wound care for their patients.

    The American Society for Mohs Surgery is committed to ongoing education and support for clinicians interested in this skin cancer surgical technique. To learn more about our courses and membership, call 616-2767.

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