Quick Summary
- A patient named Emma underwent Mohs surgery for squamous cell carcinoma on her left temple, which cleared after two stages and was successfully closed.
- During pre-closure assessment, the surgeon noted an irregular heartbeat consistent with atrial fibrillation, despite the patient reporting no related medication or known issue.
- The surgeon contacted her primary care office and insisted she be evaluated immediately due to stroke risk, resulting in an appointment within an hour.
- Follow-up the next day confirmed she was started on warfarin, felt well, and had no significant pain from the incision while continuing post-op care.
- The surgeon reflects that internal medicine training and attention to detail helped identify and act on a serious medical issue beyond the skin cancer treatment.
It was a typical Tuesday afternoon and we started our second set of Mohs surgery patients. Emma had a squamous cell carcinoma on her left temple. After the initial excision, she already had a dime-sized hole in her head! Fortunately, her lesion cleared after two stages of surgery.
We took her back to our ambulatory surgery center, where we listened to her heart and lungs, measured her oxygen level, and took her blood pressure.
While listening to her heart, I noted that the heartbeats were not steady. I asked her about this and she stated that her heart rate was normal and that she was not on any medication to regularize her heart rate. We went ahead and proceeded with the closure which went very well. I felt her pulse again after the procedure. The rate was irregular, typical of Atrial fibrillation.
I asked who her general doctor was and put in a call to him myself. After two phone calls, I reached the triage nurse who asked if it was necessary that she be seen today or if it could wait till tomorrow. I responded: “if you want to take responsibility for this patient having a stroke tonight she can wait till tomorrow otherwise she has to get into see her physician or go into the emergency room immediately.” The nurse clearly heard where I was coming from and scheduled an appointment with her doctor within one hour. I informed my medical assistant to relay the news to the patient Emma and she was to be there at 4:30 PM.
I thought about her the next day and asked my medical assistant to give her a call in order to obtain information on her visit the afternoon prior. She stated she was feeling fine, and that the MD put her on warfarin and is very very comfortable, without any pain from her incision. I encouraged her to continue following the post-operative care guidelines, as this would be crucial for her healing. She mentioned that she was aware of the mohs surgery recovery timeline and was committed to taking her medications as prescribed. Overall, it was reassuring to hear that she was adjusting well to the treatment and had no significant concerns. She also expressed her appreciation for the care she received during her mohs surgery for nose treatment, noting how the staff made her feel comfortable throughout the process. As she continues to heal, I emphasized the importance of monitoring her incision site for any signs of infection and encouraged her to reach out if she had any questions or concerns. It was clear that her positive attitude was greatly contributing to her recovery journey. She expressed relief that the procedure was successful and felt optimistic about her future. Recognizing the significance of her experience, she acknowledged that the mohs surgery for skin cancer had not only improved her physical health but also her outlook on life. As we wrapped up the conversation, I reminded her that ongoing support and communication would be vital as she continued her recovery process.
Lesson to be learned: The two extra years I spent in an internal medicine residency paid off again, as well as being astute to details and taking action. I’m not just a dermatologist or dermatologic surgeon, I care about my patients as a whole.
