Prophylactic Antibiotics Before Outpatient Surgery?

[DRM18]

Hi everyone,

Well, as soon I finished treatment (V + O) last month, I discovered a basal-cell carcinoma on my head. Fun!

Getting it removed Tuesday (May 4) as an outpatient. Meeting with the surgeon Monday for a chat.

Obviously I’ll ask him this question, but I figured I’d throw it out here in the meantime: should I request a prophylactic antibiotic? My labs are all normal, save for the WBC & ALC, which are the high side of low: 3900 & .9 respectively. ANC at 2.something.

Any informed opinions? I try to avoid antibiotics whenever possible, FYI.

Thanks, regardless.

—Dave!

[AussieNeil Partner Administrator]

Your low lymphocyte count means that your adaptive immunity (B and T cell mediated) will be low, but what's most important with regard to the most common risk with surgery addressed by prophylactic antibiotics - bacterial infection, is your innate immunity, where your neutrophil count is the most important. Given your neutrophils are above 2, I doubt your CLL specialist will recommend a prophylactic, but you should check with them as well as your surgeon.

Neil

[DRM18 in reply to AussieNeil]

Thanks, Neil.

You never disappoint, my digital friend.

—Dave!

[GMa27]

I am in remission now. While on W&W or during remission, I never am instructed to take anything for procedures. I have had plastic surgery, Moh's, dental work, etc. Always check with your hematologist. Everyone is different.

[DRM18 in reply to GMa27]

Thanks, GMa27.

Your knowledgeable reply has helped ease my obsessive thinking.

Cheers!

[opal11uk]

Yes, no harm in asking is there and if it would make you feel more relaxed then all the better. I too have the same and waiting on a dermatologist, I had one on my face and waited over a year to have it removed so looks as if I am in for a long wait with the one on my head but next week I shall get on to my doctor to expedite matters! ps I dont have CLL, hubby does.

[DRM18 in reply to opal11uk]

Thank you, Opal.

[Hilomom]

I'm in watch and wait and just had a Squamous Cell Carcinoma removed from my arm. I didn't take anything.

[DRM18 in reply to Hilomom]

Thanks, Hilomom. Glad to hear you didn't need anything.

[Etoile7]

I am very sorry to read about this, Dave. I have no special advice, but hope all will go well and that it’s the end of your roller coaster for a while! 😀💪

[DRM18 in reply to Etoile7]

Thanks, Etoile. Yeah, this particular roller coaster is not much fin at all. Too much screaming lol ...

[MGirl-Aust]

Hi Dave,

As this is ‘clean’ surgery (ie not something like gastrointestinal surgery or a dirty wound), I would be surprised if prophylactic antibiotics were required, especially with your blood counts. I also try to avoid antibiotics wherever possible and would not ask for them in this situation. (I’m on V+O at the moment and not taking valaciclovir or Bactrim - haematologist said he didn’t think I needed them and I’m quite comfortable with that.)

Hope the surgery goes well.

Michelle

[DRM18 in reply to MGirl-Aust]

Thanks, Michelle.

That's a useful distinction you've drawn. It helps explain the cause of my question, which is that CLLers often take antibiotics before/after getting their teeth cleaned, which I'm guessing is a very minor, but "dirty" procedure?

[MGirl-Aust in reply to DRM18]

Hi Dave. My understanding is that the mouth is not ‘dirty’ in the same way as for example the bowel is. For minor dental procedures antibiotics are not usually required, but would be considered on a case by case basis and may be recommended if someone is significantly immunosuppressed, has an infection in the mouth, or has heart problems with risk of endocarditis. I recently had a tooth removed and the surgeon did not think I needed prophylactic antibiotics. I was on W&W at the time.

[DRM18 in reply to MGirl-Aust]

I thank you again, Ms. Michelle!

[Teddo]

Just had basal cell carcinoma removed from scalp this past Thurs. I notified the MOHS surgeon ahead of time re my CLL. No antibiotics were used pre or post surgery. So far so good. My ALC has been running in the 60,000's, on w+w.

[DRM18 in reply to Teddo]

Oh, interesting, Teddo!

If you don't mind my asking, are you wearing a bandage? If so, and if you have hair, isn't that a particular challenge? And can you lay your head on a pillow okay?

Somebody stop me from asking questions!

[HopeME in reply to DRM18]

Hi DRM

I’ve had several of these removed. The last one occurred summer 2020 when I had one removed from the side of my nose. I was about two years from my final chemo treatment at that time. First, no antibiotics were recommended. However, that may be a different for you since you just finished treatment. As Neil notes it’s all about those neutrophils and they may be more susceptible to decline right after treatment. Please let us know what your doctor tells us if you don’t mind. As far as bandages, my recollection is I had to keep one on for about the first 24-48 hours and then I was able to remove it. There was a substance placed over the dissolving stitches which gradually fell off during the first week or so. Getting Basal cells removed isn’t difficult or painful. It truly has been a non-event for me the three times Ive had it done.

Good Luck!

Mark

[DRM18 in reply to HopeME]

Thanks so much, Mark. Hope is what I need now, & your generous response has provided some.

—Dave!

[Teddo in reply to DRM18]

Dave-

Yes, I am wearing a bandage and will likely do so for at least 2 weeks covering over petroleum jelly as the only treatment. My lesion was on the crown of my head where I am mostly bald. The lesion was abt 2/3 the size of a dime. It took 3 passes to remove all cancer cells. When they showed me a photo post op, I was shocked. The " hole" in my scalp was about the size of a quarter and cutting went down to the skull. Three days later I feel little pain. My wife assured me this morning the hole appears to be somewhat smaller. I was told new tissue/skin will come from the bottom up.

Good luck with your procedure. There is plenty online re MOHS procedure.

[DRM18 in reply to Teddo]

Thanks, Teddo!

No MOHs for me, though, as the doctor doesn’t want to leave an open wound on my head, as I’m a slow healer. He’s gonna stitch it it up, or, barring that, use a little flap & stitch that up, or, worst case, use a “little skin graft,” depending on what the analysis reveals. I’m terrified!

Hope you continue to heal briskly!