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Welcome
We are pleased that you have chosen us for your surgical care. Our goal is to provide the quality care and expertise that you expect and deserve.
This brochure will help you to understand how our facility works and answer some of your questions so you will be prepared for surgery and the follow up care.
Please feel free to ask any questions regarding medical care, fees, insurance, or other office policies. We are concerned about you and welcome any suggestions that will improve the care that you receive. It is essential that our patients are well informed, relaxed, happy and above all, confident.
Mohs Micrographic Surgery
What is Mohs Surgery?
Mohs Micrographic surgery is a safe and highly effective technique whereby skin cancers are removed under complete microscopic control. Dr. Fredric Mohs developed the specialized technique in the 1930’s. In Mohs surgery, a thin layer if skin is removed around the visible cancer. Detailed maps are then drawn of the area, and the tissue is completely examined under the microscope to be sure all the cancer and its roots are gone. If any cancer remains, that exact area of involvement is sampled, and the entire process is repeated until the cancer is totally eradicated.
What is the advantage of Mohs Surgery?
By using the mapping technique and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. Benefits of this meticulous technique include its ability to serve as much normal skin as possible and offer the highest possibility for curing the cancer.
What to expect the day of your surgery
Surgery begins early in the morning and is performed in the office, on an outpatient basis. A local anesthetic is injected into the skin to numb the area to be treated. Once the area is numb, the visible cancer is removed as well as a thin layer of tissue around the cancer. A temporary dressing is applied and you are escorted to our waiting area. This part of the procedure takes only 10 to 15 minutes. The tissue is then mapped by the surgeon and taken to our laboratory where it is color coded, processed and examined under the microscope. This part of the procedure takes about one hour while you wait in the reception area. If any additional affected area is identified, the process is repeated until all of the cancer is removed. The number of stages or layers required varies for each patient and depends upon the size and depth of the tumor. On average, most patients have two or three layers of tissue removed. Since we cannot predict in advance the number of stages necessary to fully remove the tumor, you should plan on spending the whole day with us.
Once the area is cancer free, the surgeon will discuss the options of wound healing and surgical repair. This may include suturing the area, performing reconstructive surgery using a skin graft of flap, or allowing the area to heal on its own. If surgical repair is required, it is done in our office on the same day as the Mohs surgery with rare exception. Following the repair, a dressing is applied and you will be given instructions on wound care and dressing changes.
Preparing for your surgery
Breakfast: Because the procedure is performed under local anesthesia, you may eat breakfast in the morning.
Medications: Please take your daily prescriptions medications prior to surgery, especially, blood pressure medications. Also bring a list of your medications with you, including non-prescriptions drugs.
You may take Tylenol anytime before surgery if needed for pain.
If you have been prescribed Coumadin, Aspirin, Vitamin E, or Plavix for serious medical reasons, please contact your physician to see when and if this can be discontinued prior to your surgery. If discontinuation is not recommended, please continue taking your medication as ordered. We can still perform your surgery.
Alcohol: Alcohol will also promote bleeding. We ask that you avoid alcoholic beverages 24 hours before and after surgery.
Smoking: Smoking can affect wound healing by diminishing blood supply at your surgery site. We ask that you discontinue smoking 2 days before surgery and 1 week after surgery. If you can not discontinue entirely, cutting back to less than 1 pack per day is high recommended.
Transportation: It is necessary that you make arrangements for someone to drive you to and from our office the day of surgery. This person may stay with you during the waiting period to keep you company between layers. Although you may be finished earlier, please plan on spending the entire day with us.
Passing Time: 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 the microscope slides to be processed and examined. Coffee, cookies, and magazines will be available in the reception area.
Lunch: We recommended you bring a lunch with you. We can refrigerate your lunch when you arrive. Your companion may bring you a snack or lunch from several eateries that are located near our office since you are asked not to leave the reception area of our office.
Attire: We ask that you dress comfortably the day of surgery.
After Surgery
If you have any problems at home after surgery, please do not hesitate to call our office. We will be glad to answer any questions. Instructions for wound care will be given to you at the end of your day.
Will I have pain after surgery?
The surgical site may be sore for several days after surgery. If there is any discomfort, Tylenol is usually adequate for relief. Avoid taking aspirin or ibuprofen-containing medications as they may cause bleeding.
Will I have bruising after surgery?
Bruising and swelling are common after surgery. This may not peak until 48 hours following the surgery. We do not recommend planning your surgery date around an engagement where physical appearance is important.
Can I exercise after surgery?
Activities, including exercise or heavy lifting, will be restricted until stitches are removed. The more activity you participate in after surgery, the more likely you may bleed from the surgery site.
Will the surgery leave a scar?
Whenever any form of surgery is performed, there will be a scar. Any scaring is minimized because the Mohs technique removes as little tissue as possible.
Will I need to come back?
Suture removal and wound evaluation is usually performed one week after surgery. Periodic visits at least once a year to your referring physician are advisable to monitor for new skin cancers or signs of recurrence from previous procedures. Since statistics show that a patient with skin cancer has a higher chance of developing another one, follow-up is very important.
How can I protect myself from developing more skin cancers?
Here are some helpful hints to avoid the damaging effects of the sun and protect your skin from more 0injury:
1. Regularly and liberally apply a board spectrum sunscreen (SPF 15 or greater with UVA and UVB coverage) on a daily basis. Reapply every 2-3 hours during prolonged sun exposure.
2. Cover up with protective clothing, hats, beach umbrellas, etc. even on cloudy days, to minimize unnecessary exposure.
3. Avoid the sun at its most intense hours form 10:00 am to 4:00 pm if possible. If not cover up!
Sun protection is extremely important to minimize further damage to your skin and the risks of development of additional skin cancers. Enjoy the outdoors, but do it wisely.
Insurance and Referral Information
We participate with most insurance plans. We will submit all claims to your insurance company. Expenses not covered include cosmetic procedures, deductibles, co-insurance, co-pay amounts and occasionally office visits. These fees will be collected at the time of services. Payments may be made in cash, check or credit card. Please check with your insurance company if you have any questions about coverage or preauthorization.
If prior authorization is required, please contact your insurance company or your Primary Care Physician before surgery. It is important that you tell them the following code information so that your referral is correct. You are having Mohs surgery (code 17304) for skin cancer (diagnosis code 173.9) and it will be performed in the office.
We would not want anyone to be denied medical care because of an inability to pay. If you have any difficulties understanding or paying your bill we encourage you to discuss your problem with our office at (973) - 376 8500 Ext 13.
Parking Instructions (Day of Surgery)
Park behind the movie theater (Deforest Avenue) or on the side of our office in the rear (Bank Street).
Please give the receptionist your license plate number and the parking space number when you arrive. She will notify Parking Authority so that you are not ticketed. | 
