Skin Cancer Removal/Reconstruction FAQs

• What is skin cancer removal/reconstruction?

  Skin cancer can develop on the face around the eyes. Skin cancer can be removed surgically. Depending on the circumstances, sometimes our dermatologic surgery colleagues ask Dr. Mettu to perform the surgical removal with frozen sections where a pathologist helps ensure the cancer has been successfully removed. Then, in the same surgery, Dr. Mettu can repair the defect (missing tissue).

  Click to read about skin cancer reconstruction and see photos.

• Where is the surgery performed?

  The surgery is performed at UNC REX Hospital. Review additional information about surgery at REX Hospital.

• What are the planning considerations?

  An adult will have to drive you to surgery, stay there, take you home, and stay with you for 24 hours after surgery. You and your guest will be at the hospital for approximately 5 hours.

  You cannot drive for 24 hours after anesthesia.

  When possible, avoid surgery within 3 months of any major events (weddings etc.).

  Expect bruising and swelling after surgery. Though the bruising and swelling will not be fully resolved after 14 days, there is significant improvement after 14 days.

  Dissolvable sutures are used for reconstruction. In some cases, it may take over a month for sutures to dissolve.

  There are scars after skin cancer reconstruction. Though these will fade, it takes up to a year to see stabilization in the scar and healing process.

• What are the restrictions after surgery?

  Avoid strenuous activity until day 11 after surgery. On day 11, you may resume exercise at 50% effort and slowly build back up.

  Avoid bending and lifting until day 11.

  Do not rub, pull, or press on the surgical site.

  Do not go swimming until day 11 after surgery. Incisions may get wet and you may shower but avoid direct pressure from the shower head.

  Do not drink alcohol until day 11 after surgery as alcohol can thin your blood and increase the bleeding risk.

  Do not wear make up until day 11 after surgery.

  Do not wear contact lenses until day 15 after surgery.

• What medications will I need after surgery?

  At the pre surgery clinic visit, we will send in the prescriptions for you. We will prescribe:

  antibiotic ointment to use on the sutures three times a day for ten days and then nightly until the sutures dissolve

  You should also have the following over the counter medications available for use post operatively:

  artificial tears to use as needed for dryness/irritation

  Tylenol for post operative pain (if this does not adequately reduce your pain to a tolerable level, please let us know)

• When are the post op appointments?

  We will schedule the first post op appointment typically around 7-14 days after surgery. Sutures will not be removed - they will be allowed to dissolve as noted above. In some cases, the first post op visit can be scheduled by telemedicine video call if desired. There is one more post op appointment approximately 2 months after surgery. After that time, patients follow up as needed.

• What else do I need to do to prepare for surgery?

  Before the pre surgery clinic visit, you should review the following information:

  Review all of the information on this page in detail.

  Review the pre op instructions.

  Review the post op instructions.

  Review the skin cancer removal/reconstruction consent form (you will sign this in the office after evaluation by Dr. Mettu).

  You should also:

  come to the pre surgery clinic visit prepared with questions

  contact your insurance company as noted below with questions about insurance related costs

• What is the insurance based cost?

  Here is a break down of the insurance costs for skin cancer reconstruction surgery.

  Based upon your insurance, a rough estimate for the surgeon's fee for skin cancer removal/reconstruction will be prepared and provided to you by text message and/or at the pre surgery visit.

  We consider this a rough estimate as the amounts you will owe will not only depend on your specific insurance contract (unmet deductible/coinsurance) but also on how the removal/reconstruction is performed - this is something that cannot always be reliably predicted prior to surgery. The amounts you will ultimately owe for medical care are not arbitrarily set by our office - they are dictated by your insurance plan. When applicable, a deposit for the surgeon's fee (based upon our estimate) is due at least 7 days prior to surgery. Once the claim comes back from your insurance company, you will receive an explanation of benefits (EOB). We will contact you if any adjustments (issuing a refund or collecting additional balance) need to be made, but you should reach out to us as well if you have questions once you have your EOB.

  There will also be claims submitted by REX Hospital and the anesthesia group. You may also have some financial responsibility for the facility fee and the anesthesia fee based upon your insurance contract. Unfortunately, due to the complexity of medical insurance billing, we cannot provide estimates for your facility fee and anesthesia group (more info below.)

  The best source of info for cost related questions will be your insurance company. You can contact them by calling the number on the back of your card.

  Here is some info your insurance company may ask for:

  A CPT code we sometimes use for skin cancer removal/reconstruction is: 67966

  The above code is not always used and sometimes there are several other codes that may be used

  If other codes are more applicable for the purposes of your estimate, we will let you know after you have been evaluated

  Pradeep Mettu, MD NPI is 1215236419

  UNC REX Hospital NPI is 1497797088

  For questions about facility fees at UNC REX Hospital, call 984-974-2222.

  For questions about anesthesia billing through American Anesthesiology, call 866-306-6007. If you are asked how long the surgery may take, an estimate for this purpose is 75-145 minutes.

  The UNC REX Perioperative Planning Center may also be a good resource for general questions about the logistical aspects of surgery. The phone number is 919-784-3102

• What time will my surgery be?

  We will give you a preliminary surgery time at your pre surgery clinic visit. You will receive a text message a few days before your surgery date with your finalized arrival and surgery times.

• What happens next?

  If you are an existing patient who has been seen in our office recently, were sent this information to review, and are interested in proceeding with surgery, text and let us know:

  if you need an insurance quote for skin cancer removal/reconstruction

  dates you CANNOT do with regard to the pre surgery visit, surgery date, and first post op visit

  we will then text you proposed dates based upon our availability (Dr. Mettu operates on Wednesdays and Fridays)

  once a date for surgery is finalized, we will use the date to submit for authorization from your insurance if applicable

  If you have not been seen in our office and would like to be evaluated, you can schedule online.

  If you are scheduled for a pre surgery clinic visit and surgery and are reviewing this information before your appointment, see you soon!