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Patient Care Most Frequently Asked Questions
(Click on desired question; most answers will appear near top of page; then click up-arrow to return)
PREPARING FOR SURGERY
THE DAY OF SURGERY
AFTER SURGERY
What about my medical history? What happens the day of surgery? Will I need to come back?
What about my medications? Will I be hospitalized? How can I protect myself from developing more skin cancers?
What about transportation (and safety)? Will the surgery leave a scar? What about sunscreens?
What about breakfast? Why would a wound be allow to heal itself? What about my outdoor life style?
Will my insurance cover the costs? Will I have pain after the surgery?  
PREPARING FOR SURGERY
What about my medical history?
Upon arrival at our office you will be asked to complete a medical history form. It may be helpful for you to bring a list of medications and illnesses. Please also request that your referring doctor forward a copy of your biopsy report and any other pertinent records to our office prior to your appointment.
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What about my medications?
Continue any medications prescribed by your doctor. However, aspirin is a drug that may prolong bleeding. We ask that you avoid aspirin and aspirin-containing products (including Anacin, Bufferin, Excedrin, Alka Seltzer, and Percodan), and products containing Ibuprofen (Advil, Motrin) for one week prior to surgery. You may take Tylenol any time before surgery if needed for pain. If you are taking blood thinners, (Coumadin, Plavix), please call our office before your scheduled surgery. In addition, alcohol will also promote bleeding; so avoid alcoholic beverages 24 hours before surgery.  Please avoid wearing make-up, perfume, nail polish, and jewelry, as these may also interfere with the areas to be treated.
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What about transportation (and safety)?
It is strongly recommended that you arrange for a companion to drive you to and from the doctor's office on the day of surgery.  Even though many surgeries may seem "minor," sometimes the necessary bandages may interfere with vision or mobility, and can make driving dangerous.  In addition, some patients may require a light sedative for surgery and will be prohibited from driving afterward.
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What about breakfast?
We suggest that you eat a normal breakfast on the day of surgery, unless other special instructions have been provided by your referring physician.
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Will my insurance cover the costs?
We accept assignment on Medicare, and many other insurers. If you have questions regarding which secondary insurance plans we bill, or if you have questions regarding submission of a claim to a secondary insurance company, our business office staff will be happy to assist you.  Expenses not covered include insurance deductibles, co-pay amounts, and occasionally office visits and surgery center deductibles. Please check with your insurance company if you have questions about coverage or pre-authorization. We would not want anyone to be denied medical care because of an inability to pay. If you have difficulties understanding or paying our bill, we encourage you to discuss your problem with the Business Office staff.  Also, please contact your insurance company before surgery if prior authorization is required.
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THE DAY OF SURGERY
What happens the day of surgery?

In order to expedite treatment of skin cancers, Dr. Griego offers several different types of appointments. You may be required to return the day following Mohs surgery, or you may be coordinated with one of our Plastic Surgeon colleagues for wound repair. We will recommend the best option for your specific circumstances since waiting lists often vary significantly between the appointment types.

Appointments for surgery are scheduled early in the day. This allows us to complete several surgical stages throughout the day (if necessary) and relieves you of having to make another trip to the office the next day. Our staff will escort you into a surgical suite where Dr. Griego will perform a detailed pre-operative consultation including: a review your medical history and pathology reports; a comprehensive examination of your skin; and customized answers to any questions you may have regarding your diagnosis and the procedure. 

When you are ready, Dr. Griego will use a local anesthetic to numb the area around the cancer. Once it is numb and cleansed, the procedure will be initiated by the removal of the visible portion of the tumor by either curettage or excision. When the visible portion of the tumor is debulked, a thin layer of tissue will be surgically excised completely around and underneath the skin cancer. This layer of tissue is generally 1-2 mm in thickness. The excised tissue then will be carefully inked, diagramed, and processed in the laboratory which is  contained within the office.  The tissue is then frozen, cut into microscopically thin sect ions, and then processed through a staining machine to make visible all of the cells contained within the specimen.

Once the microscopic slide is prepared, Dr. Griego will personally examine the entire undersurface and outside edges of the tissue that surrounded the skin cancer.  Any tumor that is seen remaining during the microscopic examination will be carefully marked on the map which precisely locates that area relative to the patient's skin.  An additional thin layer of tissue is then excised from the exact area that demonstrated the involvement with cancer.  This sequence will be repeated as often as necessary to completely remove the cancer.

We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for microscopic slides to be processed and examined. Magazines and beverages will be available in the waiting room area. Most patients find it helpful to bring along a friend or family member to help them pass the time. Although this is STRONGLY encouraged, we ask that you limit the number of companions to ONE because of the limited capacity of our waiting area. If your visit extends through the lunch hour, your companion may wish to visit one of the neighboring restaurants to bring you a snack or lunch. Because of possible complications with bleeding, all patients are asked not to leave the waiting area of our office. The most difficult part of the procedure is waiting for the results of the surgery.  Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be in the office the entire day and that you make no other commitments.
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Will I be hospitalized?
No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day.  Hospital facilities are available if necessary.
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Will the surgery leave a scar?
Yes.  Any form of treatment will leave a scar.  However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized.  Immediately after the cancer is removed, we may choose (1) to leave the wound to heal itself, (2) to repair the wound with stitches, or (3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result.
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Why would a wound be allowed to heal itself?
In some instances allowing a wound to heal without surgical reconstruction is the best option. In some anatomic locations natural wound healing results in a better cosmetic outcome than even the best surgeon's reconstruction.  In other instances the tissue-sparing benefits of Mohs surgery allow removal of a cancer with a resultant wound so superficial that there is literally nothing to stitch up. If the wound is allowed to heal by natural processes, it usually heals in 3 to 8 weeks, depending upon the size and depth of the wound. During this period of time, daily bandage changes and wound care provided by the patient expedite the process and prevent infection. The most modern wound healing methods will be explained by the medical staff and provided in written detail to clarify the patient's responsibilities.
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Will I have pain after the surgery?
Most patients do not complain of pain. If there is any discomfort, Tylenol is all that is usually necessary for relief.  Avoid taking aspirin-containing medications as they may cause bleeding. If you know that you typically require a narcotic for pain relief after minor surgery, please do not hesitate to request this on the day of treatment. 
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Will I need to come back?
Usually, one return visit is needed to examine the healed surgical site or to remove stitches.  For certain types of reconstruction you may be asked to follow up in six weeks or even three months to make sure this has healed to your satisfaction. Afterwards you may return to your referring physician for routine check ups.
A follow up period of five years for the treated cancer is essential. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once each year, not only to examine the treated skin cancer, but also to check for new skin cancers.
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How can I protect myself from developing more skin cancers?

The best protection from skin cancer is to avoid the harmful ultraviolet rays of the sun. Even if you tan easily, the sun can contribute to skin cancer in two ways. First, the sunlight damages the genes that control cell growth; and second, sunlight damages the body's immune system so that early cancers grow unchecked by normal immune defenses.
Therefore, it is recommended that you minimize your exposure to the sun by these methods:

  1. Use a sun-screen with a Sun Protectant Factor (SPF) of 
    at least 15 and preferably 30 with UVA/UVB protection when you spend any time in the sun.
  2. Avoid exposure during mid-day hours (10:00 a.m. to  4:00 p.m.).
  3. Do not stay outdoors unprotected on cloudy days since the ultraviolet light penetrates easily through the clouds.

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What about sunscreens?
Recently, the benefit of sunscreens has been questioned. Some have even gone so far as to blame sunscreens for causing some forms of skin cancer. There is no scientific proof to these allegations. Although scientific studies are never perfect, recent studies which have formed the basis for the denouncement of sunscreens are terribly flawed.  In addition, since sunscreens provide the best protection presently available against the sun's harmful rays, their use is an important part of a sun safety protocol.

Dr. Griego recommends sunscreens with an SPF of at least 15 for daily use and 30 or higher for prolonged outdoor activities. Products which block the UVA wavelengths and are waterproof/sweat-proof are preferable. Specific active ingredients to look for are Titanium Dioxide, and Zinc Oxide (Non-opaque - microsize formulations), and Parsol 1789. Good examples are Shade UVA Guard, PreSun Ultra, and SolBar spf 50. For both men and women a good sunscreen containing moisturizer serves two purposes. The sunscreen should be at least an SPF 15. Good examples which are non greasy include Oil of Olay Daily UV Protectant, Neutrogena Moisture, and Purpose.

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What about my outdoor life style?
Unfortunately, people who love the outdoors are frequently those most afflicted with skin cancer. Activities such as golf, boating, fishing, hiking, hunting, and camping, are not amenable to an indoor setting. For many, these activities provide some of life's greatest enjoyment and are important to one's mental and overall health.  Fortunately, for most skin cancer patients, these pastimes need not be abandoned in the name of prevention.  However, for nearly all patients, observation of the sun protective strategies outlined above, is paramount to protect against the development of new skin cancers.
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