Here are some questions that our patients frequently ask us.  Hopefully these answers will help you and make your surgery day more comfortable.

What is basal cell carcinoma?
What is squamous cell carcinoma of the skin ?
Why did I get a skin cancer?
Are skin cancers life threatening?
What is Mohs surgery?
How is Mohs surgery different from other types of surgery?
How long will my surgery last?
What should I bring with me and what should I wear?
Should I bring anyone with me?
Should I skip breakfast before the surgery?
Should I take all my medications on the day of the surgery?
Will I have a scar?
Do I need to take antibiotics before the surgery?
Can I have surgery if I have a pacemaker?
Will I be able to exercise or go back to work after surgery?
How should I clean my incision?
What do I do for pain?
What if I have a concern or problem after the surgery?
Will insurance cover the procedure?
Do I need a referral for my visit?
Once I have had completed all necessary post operative visits with Dr. Raynham who do I see for my future skin care?


What is basal cell carcinoma?
Basal cell carcinoma is the most common type of skin cancer.  It does not spread to distant sites, however if not removed it might continue to grow leading to a non- healing sore.  Some basal cell carcinomas if left untreated for many years, can cause local tissue destruction. This might result in deformities of the eye, nose or ear, if the tumor is already growing in those areas.

What is squamous cell carcinoma of the skin ?
Squamous cell carcinoma is a type of skin cancer that can be cured if treated early.  If left untreated, and if it is an aggressive subtype, there is an extremely small risk that it might spread to the lymph nodes.
 
Why did I get a skin cancer?
Skin cancers develop from multiple causes.  One of these is sun exposure, especially as a child.  In addition, skin cancer is more common in certain families, particularly those with fair complexions.

Are skin cancers life threatening?
Basal cell carcinomas and squamous cell carcinomas are rarely life threatening.  They generally do not spread to other areas.  Malignant melanoma, the third most common form of skin cancer, can be life threatening if treated late.  Melanoma if treated early, can be cured.  Squamous cell carcinoma and basal cell carcinoma do not become or turn into malignant melanoma.

What is Mohs surgery?
Mohs surgery is a type of skin cancer treatment in which the physician uses both surgery and the microscope when removing a skin cancer.  It is called Mohs surgery, after Dr. Frederic Mohs, who developed this technique about 65 years ago.  This procedure has been refined and modified over the past years.  Mohs surgery is also called Mohs micrographic surgery.   Mohs surgery offers the highest cure rate for skin cancers such as basal cell carcinoma and squamous cell carcinoma.

How is Mohs surgery different from other types of surgery?
The difference is that the surgeon exams the tumor tissue under the microscope after the tumor removal.  Specifically, after the removal of the obvious skin cancer, the surgeon takes a small layer of normal appearing skin surrounding the tumor.  A map is made of the skin specimen which is removed.  It is then processed in the laboratory.  The processing takes about thirty minutes to one hour.  The surgeon then looks at the specimen under the microscope.  If tumor is present at the edge of the specimen, then the Mohs surgeon marks the area on the map, and returns to the patient and removes more tissue in that location on the patient.  This process is repeated if necessary until the tumor is 100% removed.
 
How long will my surgery last?
The length of the surgery varies, depending on how large the tumor is, and depending on whether the surgeon needs to remove more tumor after the first stage of tumor removal.  Most of your time at the office will be spent waiting while the tumor is processed.   However, expect to be at the office for at least 2-3 hours.  Some surgeries might continue for 3 to 6 hours.
  
What should I bring with me and what should I wear?
If you have a favorite CD, you might want to listen to it while you are at the office.  We recommend you wear a button down shirt or top, so that it can easily be removed or put back on without disturbing any bandages.  We also encourage patients to wear comfortable slacks.  If you are having surgery on your arm or leg, please ensure that you wear clothes that will stretch over that area, and which will not be too tight over bandages in those areas.  

Should I bring anyone with me?
Yes, we recommend you bring someone with you.  Since you might be at the office for a number of hours, many of our patients are reassured by having a family member or friend present for the procedure.   In addition, we can also share wound care instructions with your companion.  Many of our patients are unable to drive home afterwards, as bandages might prevent their glasses from being worn correctly.  

Should I skip breakfast before the surgery?
We recommend you eat a small breakfast before surgery.  Try and avoid caffeinated drinks for the morning.  If you will be having further surgery with another doctor later in the day we recommend you check with that doctor about your breakfast.
 
Should I take all my medications on the day of the surgery?
Yes, take all of your prescribed medications for the morning, unless your primary care physician has specifically instructed you to stop a particular medication.
 
Will I have a scar?
Whenever one has surgery on the skin, there always is a risk of scarring.   Furthermore, incisions change after surgery, and what one sees at 2 weeks after surgery, is very different from what one sees at 6 months after surgery.  Dr. Raynham will make every effort possible to give you the best cosmetic result.  

Do I need to take antibiotics before the surgery?
If you have had to take antibiotics before dental work or any other type of surgery in the past, we should review this issue prior to your surgery.  This can be done at your initial office visit with Dr. Raynham before the day of surgery, or if you will have surgery on your initial visit with Dr. Raynham, we will review this issue over the telephone prior to your visit.  

Can I have surgery if I have a pacemaker?
Yes, we do perform surgeries on patients with pacemakers, however you must inform Dr. Raynham and her staff about your pacemaker, and we will use a special device that will not interfere with your pacemaker.

Will I be able to exercise or go back to work after surgery?
We recommend you avoid any significant exercise for the week after surgery.  If you are having surgery on your leg, we recommend you avoid strenuous leg exercises for two weeks.  If you are having surgery on your face, you will have a bandage and stitches for a week.  Therefore some patients might want to delay their return to work for one week.  

How should I clean my incision?
Detailed wound care instructions will be given to you after surgery.  Some of these can be downloaded from our website, click here to download these instructions.

What do I do for pain?
If you are having pain after the surgery, we recommend you take extra strength tylenol.  However, if your pain persists please call the office at 978-244-0060 so that we can prescribe you medication.
 
What if I have a concern or problem after the surgery?
If you are concerned about anything after the surgery, do not hesitate to call the office at 978-244-0060.  If it is after hours, you can reach Dr. Raynham on her pager.

Will insurance cover the procedure?
Yes, in most circumstances the majority of the procedure will be covered by you health insurance.  If you have any questions don’ t hesitate to contact our staff about insurance coverage.  

Do I need a referral for my visit?
In most cases, you will need a referral from your primary care physician depending on your insurance type.  Your primary care physician’s office can obtain Dr. Raynham’s provider numbers which are necessary for the referral, by calling our office.   Most primary care physicians will provide 3 referrals which will cover all your visits with us.  

Once I have had completed all necessary post operative visits with Dr. Raynham who do I see for my future skin care?
You should make sure you follow up with your own dermatologist.  Dr. Raynham apologizes that she does not perform general skin checks. If you were referred by a doctor other than a dermatologist, Dr. Raynham recommends you see a dermatologist for general skin checks at least once a year.  

33 Village Square,
Chelmsford , MA 01824
Phone: 978-244-0060
Fax: 978-244-2522