Preoperative Concerns and Protocols at Florida Dermatology Specialists
Please review the following information about surgical procedures in the office. Please do not hesitate to call us with any questions you may have.
Blood Thinners
If the patient takes blood thinners, they should stay on them. If they take warfarin (Coumadin), they should stay on it, but make sure their INR (the blood test they do to monitor it) is between 2 and 3 and has been recently checked (within the last 1-2 weeks).
We do not recommend routinely stopping blood thinners before dermatologic surgery in the office.
Antibiotics before Surgery
The patient may need antibiotics given before surgery for any of the following procedures:
- Excision
- Destruction
- Mohs Surgery
- Staged Excision
IF they have:
- A joint replacement within the last two years and the surgery is on the lip or below the knee
- Mitral valve prolapse with regurgitation
- Artificial heart valves
- Congenital heart conditions
If a patient meets criteria and requires an antibiotic before surgery, please call the office so we can prescribe the medication and send it to the pharmacy.
Be sure to let us know about any medication allergies.
Antibiotics after Surgery
Antibiotics are generally not given after a routine excision, destruction, saucerization, or Mohs surgery.
They are routinely given after closure of a staged excision. We usually prescribe minocycline.
Alcohol Consumption
Alcohol acts as a blood thinner, so they should avoid alcohol intake 7-10 days before the procedure and for 2 days after if they are having any of these procedures.
Smoking
It is best to stop smoking, if possible, for two days before surgery and a week after for an excision or Mohs surgery. Smoking will delay the healing process. It may also lead to a worse cosmetic outcome.
Transportation
For a routine excision, ED&C (skin cancer destruction), or shave removal, the patient may drive themselves to and from the office. They may not drive to and from the office if the excision is on their face or if they have taken an anxiolytic (like Xanax or Valium) before the surgery.
Pre-Operative Anxiolytics (Medication to Relax)
We do not routinely give preoperative medication like Xanax or Valium before surgery. If the patient specifically asks for such a prescription, it must be written by the MD and sent electronically to the pharmacy. We cannot keep such medications on hand in the office for dispensing.
If they require such medication before surgery, they must have someone drive them to and from the office that day.
Confirm any medication allergies, current pharmacy of choice, and current medication list for anything they are taking and then email the request for the rx to the PA or MD.
How Long Stitches Stay In Until Removed
General guidelines:
- Face: 7 days
- Scalp: 7-14 days
- Trunk: 10-12 days
- Arms: 10-12 days
- Hands: 14 days
- Upper legs: 10-12 days
- Lower legs: 12-14 days
- Feet: 14 days
The Cancer is Gone!
Patients sometimes say the cancer has disappeared and they don’t need surgery.
A skin biopsy cannot be relied upon to resolve a skin cancer. It is very likely the cancer still is present, even if it can’t be seen with the naked eye. We still recommend having the procedure performed. It is common to still find skin cancer present during Mohs surgery, for example, even if the site looks fully healed.
Multiple Sites that Need Treatment
Patients often have more than one skin cancer that needs treatment. We can perform up to three destructions (ED&Cs) at one visit.
We can only perform one excision or one Mohs surgery at one visit, unless the second site is very close to the first and would impact the other surgery. If there are two sites that are very close together (you can see this on the photos stored in EMA), you may ask the doctor if both can be done together. If the patient has a lot of difficulty with mobility, we may perform two surgeries on the same day.