Patient Information

Your doctor has referred you to our Skin Cancer Center because the type of cancer you have requires a specialized surgical technique, Mohs Micrographic Surgery, to ensure the highest possible cure rate. For more information on skin cancer and Mohs surgery, please visit our Skin Cancer Center. We understand the term “skin cancer” can be frightening. Our healthcare team is dedicated to ensuring you receive friendly, compassionate care, as well as complete information about your condition and treatment. Please do not hesitate to ask us questions at any time.

Patient Portal Access

Pre-Surgery

Surgery Check List

Read and complete packet of information and bring it with you to your visit

***ATTENTION: FOR PATIENTS PRINTING REGISTRATION FORMS (NOT USING  PATIENT PORTAL)

In order to enhance the level of service that we provide you, we request that you complete the registration packet at your earliest convenience. Once complete, please call our medical history intake line at (919) 277-1017 to review Form D/Patient History Form. This will save you time at your visit and ensure that your medical information is organized prior to your appointment. We thank you and look forward to speaking with you!

  • Completely read our consent form in advance 
  • Please be sure you can identify the site(s) for surgery BEFORE your appointment date.  We ask your assistance because the biopsy site at times will heal making it difficult to locate. You can help us identify the location of your skin cancer by taking a photograph for reference. Please refer to the Biopsy Site Location and Submission of Photos instructions for more detailed information. We are happy to assist you in obtaining a photograph by presenting to our office prior to your day of surgery.  Please call our office at (919) 363-7546 to schedule a time for one of our clinical team members to obtain a photograph prior to your surgical appointment
  • Get a good night’s sleep before your surgery
  • Unless instructed otherwise, please have a light breakfast prior to surgery
  • Arrive 30 minutes prior to your scheduled appointment time
  • Be prepared to stay at our office several hours
  • Please continue any medications that you take on a daily basis, unless otherwise instructed. This includes any physician prescribed aspirin, Coumadin, Warfarin, Plavix and all similar drugs. Bring a detailed list of medications to your appointment. Include the medication name, dosage and frequency for all prescribed medications, over the counter medications and supplements.
  • Make sure you have taken your physician prescribed pre-operative antibiotics if necessary before surgery.
  • Stop smoking for a period of two weeks before and two weeks after your surgery to improve wound healing
  • Arrange to have a friend or relative drive you home following this or any surgical procedure

 

 

 

Day of Surgery

Consultation

Our goal is to provide you with the highest quality of healthcare. We will conduct a pre-operative consultation to review your health status, accurately locate your skin cancer, make decisions regarding your procedure and arrange for any necessary post-operative care. Our staff will review the medications you take and evaluate any anticipated problems you may have during or after your surgery. You are encouraged to ask questions concerning your skin cancer and surgery. Under most circumstances, we will be able to conduct the consultation on the same day as your surgery.

Please bring a complete list of all your prescription, over the counter medications and supplements. The list should include the correct name of the medication, the dosage and the frequency that the medication is taken. It is also important to provide us with a list of any allergies to medications. Your past medical history including surgeries and major illnesses or diagnoses should be listed with dates for our medical staff. This will assist us in providing you with the best possible care.

We will ask you about the length of time the cancer has been present and any previous treatments to that particular area.  After careful review of the pathology report and all information provided to us by your referring physician, you will be asked to confirm the location of the skin cancer. 

Surgery

Unless instructed otherwise, please have a light breakfast the morning of your surgery. A good night's rest before your surgery is helpful. Because your surgery will be scheduled early in the morning, we suggest that you make arrangements to stay in the Cary area the night before your appointment if you live a long distance from our office. We are happy to provide you with the telephone numbers of local hotels, some of which offer a discounted medical rate.

Take all medications as usual unless directed otherwise. We recommend that you continue all prescribed blood thinners.  This includes physician prescribed aspirin, Coumadin, Warfarin, and all similar drugs.  Please call our office if you have any questions or concerns about your medication.

Your surgery will be performed in our modern outpatient surgical unit. We recommend that a spouse, relative, or friend accompany you to our office. You will spend most of your time in our waiting room while your tissue samples are being examined under the microscope. Also, we strongly recommend that your companion drive following your surgery.

Shortly after your arrival at our surgery unit, you will be escorted to one of our outpatient surgical suites. At this time we will obtain your signature indicating your informed consent for surgery.

A member of our surgical team will then numb the area of skin around your skin cancer using a very small needle and a local anesthetic. A thin layer of skin involved with the cancer will be removed. Any bleeding will be controlled by cauterizing with an electric needle. The wound will be bandaged and you will be able to return to the waiting room.

While you are waiting, the piece of tissue will be processed in our laboratory where it is cut, dyed, made into slides, and read under a microscope by the doctor. This entire process usually requires about an hour.  If microscopic examination of your slides shows evidence of tumor cells in your tissue, we will return you to the surgery suite for further surgery in the areas where the tumor remains.

On average, the complete removal of your skin cancer will require two or three trips to the surgical suite. Some cancers, due to their spread into local tissue, will require more sessions to remove the tumor completely. However, even these larger cases can usually be completed in the same day, and only occasionally will we have to complete the surgery on the following day.

You should come prepared to stay all day because it is likely you will require some type of repair of the surgical wound following removal of the cancer. This is usually performed the afternoon of surgery but occasionally must be delayed a day or so. On rare occasions, we may recommend that your surgical wound be required elsewhere by another reconstructive surgeon. In that event, we will help you make the necessary arrangements.

How large will the surgical wound be after the skin cancer is removed?
It is important to realize that the tumor, which is visible to you - and to your physician - may only be the "tip of the iceberg."  Individual cancer cells cannot by seen by the naked eye. Skin cancers may form roots or "fingers" of diseased tissue that can extend beyond the boundaries of the visible tumor. For this reason we cannot predict the actual size of the tumor nor how large the surgical wound will be until after cancer removal is complete.

How will the surgical wound be repaired after the skin cancer is removed?
The size and depth of the surgical wound after removal of your skin cancer cannot be predicted in advance. The method of reconstruction cannot be predetermined, either. Following the removal of your skin cancer we will discuss with you the options for repairing the surgical wound. Most of the time, the surgical wound must be repaired by stitching it together or by more complex procedures such as skin grafts or skin flaps.

Mohs surgeons are extensively trained in surgical reconstruction. This includes basic closures, complicated skin flaps, and skin grafts. Mohs surgeons are also trained dermatologists with extensive knowledge of the skin and its healing properties. We are concerned with both the functional and cosmetic outcome of your surgical repair.

Generally, we will perform the reconstructive surgery necessary to repair the wound immediately following removal of your skin cancer; however, occasionally it is best to delay the repair. At the completion of your surgery and repair, our nursing staff will give you verbal and printed instructions on how to care for your wound

Post-Surgery

Post-Surgery

For Wound Care Instructions, click here

After hours calls
Dr. Clark and Dr. Flynn can be contacted after hours for urgent problems, by calling (919) 363-7546 and following the instructions for contacting the doctor.

 

What to expect after surgery

Discomfort or Pain
Severe pain following Mohs surgery is uncommon, but some discomfort may be noticed. We recommend that you take two extra-strength Tylenol® tablets every four to six hours as necessary. Unless your physician has prescribed aspirin or aspirin containing products, please avoid them as they may cause excessive bleeding after surgery.

Bleeding
Bleeding occasionally occurs following surgery. If this happens, do not become alarmed. Lie down and apply firm, continuous pressure for 20 minutes to the wound where the bleeding is occurring. Do not look at the wound for 20 minutes. If the bleeding continues, apply firm, continuous pressure for an additional 20 minutes as before. This almost always stops any bleeding, but should the bleeding persist, notify our office at (919) 363-7546 or go to the nearest doctor's office or emergency room for assistance.

Swelling
Swelling is common following any surgical procedure, especially around the eye. Some degree of swelling can be expected, but this usually resolves within one or two weeks.

Drainage
All surgical wounds will drain during the first week or so following surgery. Good wound care will help minimize this problem.

Infection
Infection after skin cancer surgery is unusual. Many patients receive antibiotics to prevent infection. However, if you notice thick, foul-smelling pus coming out of the wound, call our office immediately. An antibiotic is frequently necessary under these conditions.

Redness
Some degree of redness is expected following your surgery. This will resolve as the wound heals. You may experience redness at the surgical site for up to a year, depending on the circumstances of your surgery. If the redness begins to spread out from the wound, it could be a sign of infection or a possible allergic reaction to the ointment or tape used to dress the wound. Call our office and ask to speak with our nursing staff if you suspect a problem. Prolonged redness after surgery is usually an indication of small blood vessel growth around the wound.

Scarring
Scarring always occurs following any type of skin surgery. One of our goals is to minimize the size of your scar by sparing the unnecessary removal of normal tissue. However, our primary goal is the complete removal of your skin cancer. At times, a second procedure is required after your surgical wound has healed to produce an improved cosmetic outcome. We will discuss this possibility with you if it is necessary.

Prescriptions
For prescription refills please call our office during regular business hours. We have arranged for you to speak with our nurse or leave a message regarding your prescription. Please leave your full name, address, telephone number, date of birth, name of medication, and your pharmacy's area code and phone number. Your prescription will be called in by the next business day. Please note that we are unable to prescribe medication that was not originally provided by our office or refill prescriptions older than 12 months.

After the wound has healed
You will likely experience some pulling or tightness in the wound and surrounding skin during the healing period. This is normal and will diminish as the surrounding skin stretches. Itching is also a common symptom during the healing process. This is often relieved by gently massaging the scar with Vaseline or vitamin E oil a few times each day.

Skin cancers can involve the nerves in the skin. Consequently, after the skin cancer is removed, you may experience some numbness, which can last up to a year or so. The feeling generally returns, but occasionally the area will be permanently numb. If the skin cancer involves a nerve than controls movement you may experience a temporary or permanent paralysis in the area of your surgery.

The scar tissue that grows over the wound contains many new blood vessels and, therefore, will cause the scar to have a red color. The redness of the scar frequently fades after about a year.

If, after your surgery, you elect to allow your wound to heal on its own and then find the outcome to be unacceptable, we can revise your scar to achieve an improved appearance.

Follow-up visits after surgery
After your skin cancer surgery is completed, you will need to make routine follow-up visits to monitor your wound healing and look for signs of recurrence of your skin cancer or the presence of new skin cancers. These visits are vitally important in the prevention and early detection of skin cancer. Most of the time your referring physician can complete these routine follow-up visits.

If you had a wound repair procedure after your surgery, we will see you in one to two weeks for removal of stitches. You may then be scheduled for a routine follow-up visit in four to six months. After your follow-up visit, we generally have you return to your local doctor for annual visits.

In the few cases where there are recurrences of skin cancer after Mohs micrographic surgery these recurrences usually are detected within two years after surgery. Therefore, we strongly encourage you to continue your follow-up visits.

If you have had a skin cancer, you are likely to develop another in the years ahead. To minimize your problems with skin cancer, your referring physician should evaluate you if a suspicious lesion appears on your skin. A biopsy will be required to determine if the skin lesion is a cancer.

 

Office and Financial Policies

Financial Policy

Our billing office personnel can address concerns or questions regarding our fees. You may reach our billing office personnel directly at
(919) 277-1000 or (919) 303-4039. Payment for services is required at the time of your visit. We accept Visa, MasterCard, American Express and Discover Card and personal checks. Please inform our office immediately of any change in your insurance coverage.

HMO, PPO, Other Group Insurance Plans

If your health insurance plan has contracted with our office we will gladly file your claim. We do, however, require copayment, payment for non-covered services and any percent responsibility you have under your plan at the time of your visit. In circumstances where our office does not participate in your health insurance plan, the total cost of your visit is expected at the time of service. Please be aware that most insurance plans require separate approval for consultations and procedures. We will gladly assist you in this process, but you must be proactive and ensure that your plan has approved your consultation and procedure.

Office Hours / Appointments

Our office hours are:

Monday, Tuesday, Thursday       7:30 a.m.-5:00 p.m.

Wednesday and Friday               7:30 a.m.-1:30 p.m.

Patients are seen on an appointment basis.

The Cary Skin Center will make every effort to honor your appointment time. Emergencies do occur which may delay your scheduled appointment time. Our staff will keep you informed if the doctors will be delayed in seeing you. For urgent problems that require immediate attention, please call our office as early in the day as possible and ask to speak to a nurse. Based on your condition, we will make every effort to see you the day of your call.

After Hours Calls

Dr. Clark and Dr. Flynn can be contacted after hours for urgent problems by calling (919) 363-7546 and following the instructions for contacting the doctor.

Cary Skin Center Privacy Statement

Notice of Privacy Practices

Medicare

We will file with Medicare for you and receive 80% of the approved amount directly from Medicare. Medicare will automatically file for most carriers of secondary insurance. If your plan does not have this automatic filing you will be responsible for the remaining 20% at the time of service. We will provide you a receipt to attach to the explanation you receive from Medicare to mail to your secondary insurance for direct reimbursement. You will be expected to pay, at the time of service, this remaining 20% (if applicable), any unmet deductible, and any non-covered services (see below).

The Federal Medicare program, administered through the Center for Medicare and Medicaid Services (CMS), will not cover many services they consider medically unnecessary or inappropriate.  Please be advised that you will be responsible for all fees related to these services. We will attempt to advise you in advance if Medicare will not cover a service. Supplemental or secondary insurance to Medicare will not cover services denied by Medicare. We recommend checking with your insurance carrier prior to treatment if you are concerned about these issues.

Private Patients With or Without Insurance

We require a 50% payment to schedule an appointment and the remaining 50% at the time of service.

Cancellation Policy

If you are unable to keep your appointment, please provide 72 hours notice so that we may offer another patient the opportunity for an earlier appointment.  Our office will gladly reschedule your appointment; call (919) 363-7546 or email info@caryskincenter.com

Smoking

Our office is a smoke-free facility. We appreciate your cooperation with this policy.

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