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Skin Cancer on Right Hand – Squamous Cell Carcinoma (SCC)

Before Surgery                          Final Defect                              Closure                                      One Month Post Op

In addition to cancer removal surgeries, Advanced Dermatology Care offers surgical excisions of benign lesions such as epidermal cysts, lipmoas, and warts. Like any surgery, an office visit to discuss options is required before scheduling any type of removal surgery.

Schedule an appointment today to learn about you options for a benign lesion removal!

Activity

Keep activity to a minimum for the first several days. Activity increases your blood pressure, which may lead to an increased tendency for bleeding, bruising and swelling, which may, in turn, increase pain and delay healing. Relax and recline for the first day or two following surgery. For surgery on leg(s) – will need to restrict from high-impact activity (running/jogging) for a few weeks after surgery to help keep stitches from breaking open. For surgery on upper body (back/arms)- Avoid high impact sports/golf/swimming for a few weeks-months depending on how large area is and the activity.

Eating

If surgery is performed around the lower part of the face (any area below the nose and above the neck), you should minimize talking and chewing. Eat soft or liquid foods for 2-3 days following surgery.

No Smoking

If you smoke, you should stop for both two weeks before, and after, surgery. Smoking causes blood vessels to constrict (get smaller), which decreases the blood supply, delays healing, and increases the likelihood of infection.

Pain

Post-operative pain is usually minimal. Plain or extra-strength acetaminophen (e.g. Tylenol), one to two tablets every four hours, usually relieves any pain you may have. You can also try over-the-counter topical Diclofenac 1% (e.g. Voltaren gel, Salonpas, Aspercreme, etc.). DO NOT TAKE ASPIRIN, IBUPROFEN, ADVIL, NUPRIN, ALEVE or NAPROXEN- if you have any questions, refer to the preoperative sheet or ask the doctor. Applying an ice pack over the dressing for twenty minutes every 2-3 hours during the first day will help minimize the swelling and bruising as well as lessen the pain. If your pain is not controlled by these measures, call us, and we will prescribe a pain medication for you.

Bleeding

Careful attention has been given to your wound to prevent bleeding. The dressing you have is a pressure dressing which will help prevent bleeding and minimize swelling. You may notice a small amount of blood on the edges of the dressing the first day. This is NORMAL.

If you develop bleeding that seems persistent, and soils the dressing, apply firm, steady pressure over the dressing with a gauze for FIFTEEN minutes without lifting the gauze. This is usually adequate treatment. If the bleeding persists, again apply firm pressure for another fifteen minutes. If it is still bleeding, call our office, try to call the doctor, or visit your nearest urgent care, emergency room or family physician.

Swelling & Bruising

This is common and temporary, usually lasting only 1-2 weeks. It is more common in areas treated around the eyes, hands, and feet, and is usually worse in the morning. To help minimize these complications, keep the affected areas elevated as much as possible. If surgery was done on your head, you should sleep with a couple of extra pillows under your head or mattress, elevate the head of your bed frame, or sleep in a recliner. Use of an ice pack and pressure dressing, as directed above, will help. After the third day, the use of warm, moist compresses may help speed the resolution of any residual swelling or bruising. For surgery on the legs- legs take longest to heal. You may notice increased swelling in or around the ankle as the fluid is retained there while on your feet- keep feet elevated above the level of your heart as much as possible. We will most likely be putting on a dressing called an Unna Boot on the leg that had surgery. You will need to come in once a week to have the Unna Boot changed, for up to 4 weeks. If an Unna Boot was applied, keep it DRY until your follow-up visit.

Infection

The suture line will be dark pink at first, and the edges of the wound will be reddened. This will lighten up day-by-day, and will become less tender. If the wound becomes increasingly red, swollen, inflamed, warm, painful, drains pus, or you develop a red streak, fever or chills, the wound may be infected. Please call our office immediately. The antibiotics you may be taking should help minimize the chance for an infection to occur. For surgery on the leg- legs take longer to heal and at times may require additional topical or oral medications.

Nerve changes

Numbness is usually temporary, but it may last for several weeks to months. You may also experience sharp pains or “zings” at the wound site as it heals as the nerve endings are re-connecting. This is normal and will gradually decrease in frequency. Occasionally, the nerve damage is permanent and sensation, or the capability to move certain muscles, is lost.

Itching

This is very common several days, to weeks, after surgery. This is a normal part of wound healing, but it is worsened by the stitches and dressing. Once these are removed, 4-14 days after surgery, there may be a significant reduction in symptoms. After stitches are removed, topical anti-itch medicine (ie: topical Benadryl) may be applied.

Wound Care

You may remove the dressing as instructed after surgery. You may shower and wash the area as usual. However, do not let the forceful stream of the shower hit the wound directly. After your shower, you can continue to practice the following wound care instructions until you have the sutures removed:

Initially, the wound may be tender and may bleed slightly, or seep a small amount of clear pale yellow to light greenish fluid. If these fluids dry, a crust, or scab, may form over the wound. Try not to allow this drying to occur as it leads to slower healing and increases the likelihood of scarring.

To prevent crusting, the suture line should be cleansed daily with warm, antibacterial soapy water (i.e. Dial, Cetaphil, Hibiclens) let the moisture loosen any crusts and remove drainage. You may help to gently loosen the crust with a cotton swab. Finally, pat the site dry. For stubborn crusting, place gauze soaked with water or hydrogen peroxide over the wound, allowing it to soak for five to ten minutes. Loosen and remove the debris gently. You may be instructed to clean your wound with Vinegar soaks instead of warm soapy antibacterial water. Mix over-the-counter distilled white vinegar with equal parts tap water. Soak for several minutes with soft cloth 1-2 times per day.

After cleaning, apply a thin layer of antibiotic ointment (e.g. Polysporin or Bacitracin, if not allergic to) to the wound. You may also use a silver spray (Element 47 can be obtained from ADC) and cover with Aquaphor or Vaseline. Cover the wound with a non-stick dressing (e.g. Telfa, Vigilon, etc.) and gauze. Tape the dressing in place. You may use a band-aid if the wound is small. Continue this process until your stitches are removed.

Call the office IMMEDIATELY if any of the following develop:

• Excessive pain

• Decreased vision, if your surgery was near your eyes

• Any rise in temperature over 100* F

• Excessive bleeding

• Sudden swelling of forehead or eyes if surgery was on the face or scalp

• Excessive redness and warmth around wound, and or drainage

Questions or Concerns

Please call our office at (651-484-2724) if you have any questions or concerns. If you need to reach someone after our usual office hours, you may attempt to reach Dr. Rustad by calling his cell phone (651-253-6926) from a touch-tone phone. If your call is not answered, please leave your name, number and a brief message at the tone. Your call will be returned as soon as possible. If your call does not get returned within several minutes, you should proceed to your nearest urgent care or emergency room.

Return to clinic as instructed for suture removal with medical support staff.

Return to clinic as instructed for follow-up office appointment with a provider.

If your insurance requires co-pay, one will be due at your follow-up office visit.