ACM1:
MOHS' CLINIC NOTE
Patient comes for Mohs' surgery for ?? ?? ?? indistinct ?? cell carcinoma?? of the ??
??. I have discussed the nature of the lesion?? with the patient. I have discussed
the proposed ?? ?? Mohs' surgery in detail. ?? is aware that ?? large wound?? ?? ??
?? result, that ?? ?? may be necessary, and that there ?? be ?? ?? permanent ??
scar ??. Patient states ?? understands and wishes to proceed with the surgery.
Thus after signed consent, Mohs' surgery was performed as per the accompanying
operative report. ?? stage?? of excision and the removal of ?? tissue section? ??
necessary to achieve ?? tumor-free plane??. At the completion of excision the
wound?? measured ?? ?? and ?? ?? ?? ??. After careful consideration of healing and
repair options, it was elected to close this defect ?? ??. The patient tolerated the
procedure well. ?? has been given detailed verbal and printed postoperative wound
care instructions. ?? will minimize all physical activities ?? ?? ?? ?? ??. ?? will take
Tylenol with codeine No. 3 as needed for pain, return in ?? week??.
ACM2:
Local infiltration anesthesia was achieved with 1:1 ?? of 1% Lidocaine with
1:100,000 epinephrine and 0.25% Marcaine with 1:200,000 epinephrine.
ACM3:
The patient was brought to the office operating room. Careful informed consent
was obtained. Local infiltration anesthesia was achieved with the above agents.
The operative site was prepped with Chlorhexidine Gluconate and draped sterilely.
The tumor was initially debulked with sharp ??
ACM4:
Following debulking, with sharp excision, ?? Mohs' tissue ?? ?? taken which
encompassed the entire periphery and base of the wound. Hemostasis was
achieved with electrocoagulation and a temporary dressing was placed.
ACM5:
The tissue section? ??mapped, marked with tissue dyes for orientation, placed in
the cryostat, frozen to ?? degrees Centigrade sectioned at eight to ten microns in
the horizontal plane, placed on slides, stained with hematoxylin and eosin, and
examined microscopically. ?? ??
ACM6:
The patient was returned to the office operating room. Local infiltration anesthesia
was again achieved. The operative site was prepped and draped sterilely. With
sharp excision, ?? Mohs' tissue ?? ?? taken which encompassed the prior area? ?? of
involvement. Hemostasis was achieved with electrocoagulation and a temporary
dressing was placed. The tissue ?? ?? mapped, marked, and processed as
described above. Microscopic examination revealed ??
ACM7:
The patient was returned to the office operating room. Photographs were taken.
More extensive local infiltration anesthesia was achieved with the above agents.
The operative site was prepped and draped sterilely. The margins of the wound
were ?? undercut in the dermal-subcutaneous plane. Hemostasis was achieved
throughout with electrocoagulation.
ACM8:
The patient has been given detailed verbal and printed postoperative wound care
instructions. ?? is to minimize ?? physical activity ?? ?? ?? ?? ??. ?? will leave the
?? dressing undisturbed. ?? will perform daily dressing changes on the ?? ??
wound. ?? will take ?? or Tylenol with codeine No. 3 as needed for pain. ?? will
return in ?? ?? for ?? ?? ??.
ACM9:
After signed consent, the area was anesthetized with local infiltration of 1:1 solution
of 1% Lidocaine with 1:100,000 epinephrine and 0.25% Marcaine with 1:200,000
epinephrine.
ACM10:
Under ?? 1% Lidocaine local infiltration anesthesia I performed a ?? ?? ?? biopsy of
the ?? ?? ??, drysol as a styptic, ?? ?? ?? suture?? to close, polysporin ointment and
Band-Aid dressing with verbal and printed instructions in wound care. I will notify
patient by mail of the result of the biopsy and need for any further treatment.
Patient to return in ?? ?? ?? ?? for suture removal and path results.
ACM11:
Thus after signed consent, the area was anesthetized with local infiltration of 1:1
solution of 1% Lidocaine with 1:100,000 epinephrine and 0.25% Marcaine with
1:200,000 epinephrine. The operative site was prepped with Chlorhexidine
Gluconate and draped sterilely. The visible skin cancer ?? and ?? small margin?? of
normal-appearing skin was excised in ?? fusiform ellipse?? with the long axis
parallel to the relaxed skin tension lines. The level of excision was into the upper
subcutaneous fat. Following removal of the lesion the margins of the wound were
undercut ?? in the dermal-subcutaneous plane. Hemostasis was achieved with
electrocoagulation. The margins of the wound were advanced and closed ?? with
buried ?? Vicryl sutures. The surface was closed with ?? interrupted ?? Prolene
suture??. A polysporin ointment, dry gauze and tape pressure dressing was
applied.
The patient has been given detailed verbal and printed postoperative wound care
instructions. ?? will take Tylenol or Tylenol with codeine No. 3 as needed for pain.
?? will minimize physical activity. ?? will perform daily dressing changes ?? ??. ??
will return in ?? ?? for suture removal.
ACM12:
Under 1% Lidocaine local infiltration anesthesia performed a ?? biopsy of ?? ?? ??,
Drysol as a styptic, polysporin ointment and Band-Aid dressing with instructions on
biopsy site care. I will notify patient by mail of the results and need for any
further treatment.
ACM13:
MOHS' OPERATIVE REPORT
PATIENT NAME: ??
RECORD NUMBER: ??
DATE OF SURGERY:
??
INDICATIONS FOR SURGERY:
ANESTHESIA:
??
PROCEDURE:
??
STAGE-I:
??
STAGE-II:
??
STAGE-III:
??
STAGE-IV:
??
REPAIR: ??
POSTOPERATIVE CARE:
??
??
ACM14:
?? trunk, ?? extremity, head and neck check performed. ??
ACM15:
??, brown, waxy, ?? erythematous, keratotic, ?? stuck-on papule?? ??
ACM16:
?? denies allergies to medications. ?? denies a history of cardiovascular disease,
hypertension, hepatitis, bleeding disorders, immunosuppression or diabetes. No
artificial joints or heart valves. ?? does not smoke.
ACM17:
Discussion with patient. I have reviewed the nature of the lesion. I have discussed
treatment options. I have discussed the proposed ?? ?? Mohs' surgery ?? in detail
?? with the patient. ?? is aware that ?? large wound?? ?? result, that ?? may be
necessary, that there ?? be ?? ?? permanent ?? scar ??. Patient ?? states ??
understands and wishes to go ahead with the surgery. ?? have scheduled ?? for the
next convenient available Mohs' surgical appointment. ?? given ?? the usual
preoperative instructions.