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Mohs Surgery to Remove Scalp Lesions: What to Expect

Skin cancer can occur anywhere on the body, but certain areas are more susceptible than others, especially those that are regularly exposed to sunlight. As such, it’s most common for cancerous lesions to appear on the face, lips, ears, neck, chest, arms, hands, legs, and scalp. Indeed, even if you have a full head of hair and wear hats when you go outside, your scalp can develop skin cancer. Fortunately, when detected early, most forms of nonmelanoma skin cancer can be removed via a process called Mohs micrographic surgery. As opposed to a standard surgical excision, this method removes the lesion one layer at a time to preserve the maximum amount of surrounding healthy skin and yields a 98% cure rate.

Of course, most patients express some reservations before agreeing to any surgery, even one as effective and minimally-invasive as Mohs. These concerns are only amplified when the body part in question is the head or scalp, as these are sensitive and important areas, both functionally and aesthetically. So, what can one expect before, during, and after receiving Mohs surgery to remove cancerous scalp lesions? Let’s explore the process from start to finish.

Prior to the Surgery

This journey begins by receiving a skin cancer diagnosis from your dermatologist. The two most common types of nonmelanoma skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), which are often easy to see but require a biopsy or additional testing to accurately identify. If your scalp does feature one or more BCCs or SCCs, your dermatologist will then determine whether or not you’re a good candidate for Mohs micrographic surgery. Those with certain medical conditions or family histories might not be eligible to receive this type of surgery. If this is the case, a different type of surgery or treatment will be recommended.

If you are able to receive Mohs surgery, the next step is to properly prepare for the procedure. Your dermatologist will help you find the right surgeon so you can set up an appointment. It’s advised that patients stop taking certain medications before receiving Mohs, such as blood thinners and various supplements. Your surgeon will advise you according to your specific needs.

It’s also important to ensure that your schedule is completely open and free from responsibilities aside from undergoing the Mohs procedure. While the surgery and recovery times are relatively short, it’s best to give yourself some leeway in case it takes longer than expected. On the day of the surgery, wear loose, comfy clothes to calm your nerves and ensure proper blood flow, and bring something to read or play while you wait. Don’t wear any makeup as it might get in the way of the surgery.

During Mohs Micrographic Surgery

The Mohs surgical procedure typically lasts a few hours in total, though the duration can range depending on the location, complexity, and severity of the lesion(s). During this time, the patient is awake, but the area(s) in question are treated with local anesthesia to numb any pain. After the anesthesia has fully set in, the surgeon removes the visible part of the lesion as well as a thin layer underneath it using a scalpel. After placing a bandage over the wound, the removed sample is examined in the nearby lab underneath a high-powered microscope to determine where exactly the cancer is located. This part can take as long as an hour.

If cancer is detected in the thin layer beneath the visible portion, the surgeon removes another thin layer based on the information held by the previous sample. This sample is likewise examined and the process repeats until there are no further traces of cancer. If the local anesthesia wears off during the process, it is re-administered.

After the Procedure

After the cancerous lesion has been fully removed, your surgeon will decide which method is best to heal the surgical wound. If the area is relatively small and shallow, they might recommend letting it heal on its own. In most cases, however, the wound is stitched up to speed up the healing process. And larger wounds may require a skin flap or graft. In very rare cases, reconstructive surgery might be required. Most patients will end up with a scar after the wound has fully healed. If you have hair, you might be able to cover the scar on your scalp naturally. Of course, if the scar bothers you or can’t be easily concealed, your dermatologist can prescribe you scar-reducing treatments.

Lastly, plan some follow-up visits with your dermatologist to check up on the treated area and your skin overall. Even after having your skin cancer removed, there is always a small chance of recurrence. Plus, other parts of your body may be at risk as well. The frequency with which you see your doctor will depend on your skin type, risk factors, and other specific considerations.

If you have more questions or concerns regarding Mohs micrographic surgery, skin cancer, or any other skin conditions, Premier Dermatology Partners is here to help. To learn more about our team and all the services we provide, contact us.

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