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Patient Checklist

Pre-Operative Instructions

Medications to Discuss with Your Surgeon

Some medications and supplements increase bleeding. Review this list and contact our office BEFORE the day of surgery if you take any of the following.

  •  PRESCRIPTION BLOOD THINNERS. Do NOT stop warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edoxaban (Savaysa), or clopidogrel (Plavix) without first speaking to the prescribing doctor. Stopping these medications can be dangerous. We are experienced at operating on patients who take these drugs.
  •  ASPIRIN. Low-dose aspirin (81 mg) taken for heart disease: do NOT stop without cardiologist approval. Regular-strength aspirin for pain: stop 7 days before surgery if not contraindicated.
  •  ANTI-INFLAMMATORY DRUGS (NSAIDs). Stop ibuprofen (Advil, Motrin), naproxen (Aleve), and similar drugs 5–7 days before surgery. For pain relief, use acetaminophen (Tylenol) instead.
  •  VITAMIN E. Stop all vitamin E supplements 7 days before surgery. It significantly increases bleeding.
  •  FISH OIL / OMEGA-3 SUPPLEMENTS. Stop 7 days before surgery.
  •  HERBAL SUPPLEMENTS. Stop ginkgo biloba, garlic supplements, ginseng, and feverfew 7 days before surgery. These herbs impair blood clotting.
  •  IMMUNOSUPPRESSANTS OR STEROIDS. Continue taking as prescribed. Tell your surgeon if you are on prednisone, methotrexate, biologics (adalimumab, dupilumab, etc.), or organ transplant medications.
  •  BRING A COMPLETE MEDICATION LIST. Include all prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

What to Bring on the Day of Surgery

Being prepared on the day of your procedure will make the experience easier for you.

  •  A photo ID and your insurance card(s)
  •  A list of all current medications and dosages (or your actual medication bottles)
  •  Your glasses, hearing aids, or any assistive devices you normally use. You may be at the office for several hours
  •  Entertainment: a book, tablet, e-reader, headphones, or magazine to use during the waiting periods between stages
  •  Snacks and a water bottle. You are encouraged to eat and drink during the day
  •  A charged phone with the office phone number saved in case you need to contact us from the waiting area
  •  Cash or a payment method if you have a co-pay or deductible balance
  •  Any prior surgical reports, pathology reports, or medical records related to this skin cancer if not already provided

What to Wear

Choosing the right clothing makes the procedure more comfortable and keeps your clothing clean.

  •  Wear comfortable, loose-fitting clothing that you do not mind getting a small amount of blood or antiseptic on
  •  If the surgery is on your head, face, neck, or upper body, wear a shirt that buttons or zips in the front. Avoid pullover shirts or turtlenecks that must go over your head
  •  If the surgery is on your leg or foot, wear shorts or pants that can be easily rolled up above the knee
  •  Avoid wearing makeup, foundation, moisturizer, or sunscreen on or near the surgery site
  •  Remove nail polish from fingers and toes if the surgery is on the hand or foot
  •  Wear supportive, comfortable shoes, especially if the procedure area is on your lower extremities
  •  Dark colors are a practical choice since they hide minor staining better than white or light fabrics

Transportation

Plan your transportation before the day of surgery. You are able to drive yourself home in most cases, but having a driver is strongly recommended.

  •  Arrange for a driver or a companion to take you home, especially if the surgery is near your eyes, on your scalp, or on your lower legs or feet
  •  If you will be driving yourself, confirm with our office that this is appropriate for your specific surgery site and reconstruction plan
  •  Do not plan to drive after any surgery around the eye area. Swelling and temporary eye patches can impair vision
  •  Inform your driver that the procedure may take 3 to 5 hours or longer. We cannot guarantee the finish time
  •  Avoid scheduling important events immediately after your appointment. You may finish earlier or later than expected
  •  If you rely on public transportation, plan for a longer and more comfortable route home; avoid stairs or physical exertion with a fresh wound

Supplies to Have at Home Before Surgery

Stock these items at home before your procedure so they are ready when you return. Your surgeon will confirm which are needed for your specific wound type.

  •  Plain petroleum jelly (Vaseline). The most important wound care item; do not use antibiotic ointments unless specifically instructed
  •  Non-stick gauze pads (Telfa or similar) in an appropriate size for your wound
  •  Paper tape or gentle adhesive medical tape to secure the dressing
  •  Mild, fragrance-free liquid soap (such as Dove unscented or baby wash) for gentle cleaning
  •  Acetaminophen (Tylenol) for mild post-operative pain
  •  Extra pillows to elevate the area if surgery is on your face, scalp, or lower legs
  •  A thermometer to check for fever if you develop signs of infection
  •  Ice pack or frozen peas wrapped in a cloth (for swelling in the first 24–48 hours. Do not place directly on the wound)

What to Expect on the Day of Surgery

Understanding the flow of the day will help reduce anxiety. Here is what typically happens:

  •  ARRIVE on time for your appointment. Late arrival may push back the entire day's schedule
  •  You will be checked in, your surgical site will be photographed, and a brief pre-operative assessment will be done
  •  The area will be cleaned and a local anesthetic injection will be given. This is the brief sting that many patients describe as the most uncomfortable part
  •  The surgeon removes the first layer of tissue (Stage 1). This takes about 15–20 minutes
  •  You wait comfortably while the Mohs technician prepares the tissue and the surgeon examines it under the microscope. This takes 45–90 minutes per stage
  •  If cancer cells remain, additional stages will be taken. Most cases require 1 to 3 stages
  •  Once all margins are clear, the surgeon will discuss reconstruction options and close the wound
  •  You will receive written wound care instructions before leaving. Do not leave without reviewing them with a nurse
  •  Your first follow-up appointment will be scheduled before you leave, typically 1–2 weeks after surgery

About This Article

Author: , Fellow ACMS

Last Medical Review:

Audience: Physicians & Patients

Clinic: Kaplan Clinic · DermUnbound Research Program

These instructions are general guidelines. Your surgeon may give you personalized instructions that differ from this handout. Always follow the specific written instructions provided by your surgical team.