What to Expect Before Surgery

We are dedicated to providing you the very best information possible about your cancer diagnosis, treatment, and follow-up care. The following information will help you understand what to expect before, during, and after your visit to our skin cancer center.

Please get a good night’s sleep before your surgery. If you are coming to us from far away, you may want to stay at one of our local hotels the night before. Please call our office for a list of local hotels that we have arrangements with. You may eat a light breakfast before surgery, unless we advise you otherwise. Please also continue to take all physician PRESCRIBED medications as usual, including blood thinners. This includes physician-prescribed aspirin, warfarin (Coumadin), Plavix, Aggrenox, and other similar medications. If you are taking aspirin for preventative measures only and your physician has not prescribed this medication, then please stop it at least one week before surgery (ideally two weeks). If you have any questions, please call our office.

• Complete the New Patient History Form and bring it with you to our office.
• Read your consent form for surgery before you arrive.
• Check your personal schedule to ensure you will be locally available for at least two weeks after your surgery for follow-up visits and suture removal. Do not plan travel, vacations, or important events near your surgery date. We can reschedule your appointment in advance if necessary.
• Make sure you know the exact location of your biopsy site. Email pictures to us or bring them to your appointment if you have them. If you are uncertain of the location, please see page 15 for further instructions.
• Continue taking all prescribed medicines including blood thinners. Stop taking aspirin at least one week before surgery if this was not prescribed by a physician. Call our office if you have any questions about your medications.
• Avoid alcohol, Vitamin E, and fish oil supplements one week before and after your surgery since they can increase bleeding.
• If you are a smoker, then stop smoking two weeks before and two weeks after surgery to optimize wound healing.
• Get a good night’s sleep and unless advised otherwise eat a light breakfast before your appointment.
• Arrange to have someone drive you to our office and back home if you are having surgery.
• Notify our office in advance if you have an internal heart defibrillator.
• Arrive 20 minutes early for your appointment.
• Be prepared to stay at our office all morning or afternoon.

In order to provide excellent healthcare, a detailed consultation and pre-operative evaluation is performed before surgery. For patient convenience, this can often be performed the same day as the surgery. Please complete our new patient history form BEFORE arriving at our office. You will receive it in the mail, or you may download it from our web site. List all medications you are taking, drug allergies, and other past and present medical problems since many of these have the potential to affect your skin cancer surgery.

Upon arriving at our facility, you will check in at the reception desk. Please bring all of your forms and insurance cards with you. Once you have completed check-in you will wait briefly in the waiting room until a nurse escorts you back to one of our modern surgical suites. This will be your room for the duration of your stay. You and your family may either stay in this room or go back and forth to the waiting room once the Mohs procedure starts. We recommend that all patients be escorted by someone who can drive them home.

Our staff will review your medical history, medication list, allergies, and pathology report from your doctor. You will then be asked to confirm the location of the skin cancer. The exact location of your skin cancer is essential before we can proceed any further. Sometimes several weeks or more can pass between your biopsy and the skin cancer surgery at our office. The exact location is sometimes “lost” during this period of time. We recommend that you take a picture of the exact location as soon as possible. Please mark the area with a pen or point to it in the photo. Please make sure you show the lesion in respect to other areas around it. You can then bring this information to your appointment or email it to us.

If you are not certain of the exact location of your skin cancer, please assist our office with this vital information. Prior to your appointment, contact your referring doctor and have them fax us a diagram or body map that indicates the biopsy site. If they took a photo, they can email it to us.

After locating and examining the biopsy site, Dr. Viehman will review with you the Mohs procedure and his initial impressions about your particular case. He will also answer any of your questions concerning skin cancer or surgery. You are encouraged to ask questions and be completely comfortable and informed about your visit to our office. This is our goal. At this time, we will have you sign the consent form for surgery, giving us permission to remove your skin cancer. Please review this form before your appointment.

Your surgery will be performed in one of our comfortable state-of-the-art surgical suites, the same room that you have your consultation in. A nurse will numb the treatment area with local anesthesia using a very tiny needle. We take every precaution to minimize the discomfort of local anesthesia. Once the area is numb, your surgery will begin.

If you are having Mohs surgery, then you will cycle through the stages described earlier. Each removal phase of Mohs surgery only takes a few minutes. Most of the time you will be in the waiting room or resting in your treatment room. This will be approximately 45 minutes, which is the time it takes to process the tissue in the lab and for Dr. Viehman to read the slides. After each stage of surgery, the nurse will stop local minor bleeding with an electric needle and apply a small bandage. Most patients require two to three stages before the cancer is completely removed.

Please plan on being at our facility all morning or afternoon depending upon your surgery start time. We are conveniently located at Mayfaire Shopping Center should your family or friends want to go shopping or eat while they wait for you. You must remain in the office, however, for the duration of your surgery.

If you are having another form of surgery at our center, then you will not have to wait for slide processing like Mohs surgery. Laser and standard surgical patients have their treatment completed in one step. Melanoma patients may have a surgical removal performed the day of consultation and then their repair several days later. The tissue for melanoma needs to be analyzed and processed by a special skin pathology lab outside of our practice to ensure the highest quality of margin control.