Understanding Mohs Surgery on the Scalp: Before, After, and What to Expect

Mohs surgery is a specialized technique often used to treat skin cancers on the scalp.

This precise procedure involves meticulously removing cancerous tissue layer-by-layer and examining each layer under a microscope until no cancer cells remain.

For those facing Mohs surgery on the scalp, this procedure can raise many questions and concerns. In this comprehensive guide, we’ll walk through what patients need to know before, during, and after Mohs surgery on the scalp.

Why is Mohs Surgery Used for Scalp Skin Cancers?

There are a few key reasons Mohs surgery is commonly used to treat skin cancers on the scalp:

• High Cure Rates: Mohs surgery offers cure rates up to 99% for skin cancers like basal cell carcinoma and squamous cell carcinoma. This makes it one of the most effective treatments available.
• Tissue Preservation: By removing cancerous cells layer-by-layer, Mohs allows doctors to spare as much healthy tissue as possible. This precision is especially important on the scalp.
• Handles Complex Cancers: Mohs surgery can effectively treat complex skin cancers, including large tumors, cancers with aggressive growth patterns, and recurrent cancers.
• Delicate Area: The scalp contains many blood vessels, nerves, and hair follicles. Mohs surgery helps avoid damaging these delicate structures while thoroughly removing cancer.
  

Overall, Mohs surgery allows doctors to eliminate cancers while preserving normal scalp anatomy and function. This makes it the gold-standard treatment for high-risk scalp cancers.

Before and During the Treatment: What Does Mohs Surgery on the Scalp Entail? 

To understand what happens during Mohs surgery on the scalp, let’s walk through the typical process:

Pre-Op Appointment

Before surgery, patients will have an appointment to discuss the procedure and receive instructions. Medications may need to be stopped or adjusted.

Anesthesia

On surgery day, local anesthesia will be administered to numb the scalp. You will be awake during the procedure.

Removal of Visible Cancer

First, any visible tumors on the surface will be removed. This is called “debulking” the tumor.

Layer Removal & Microscopic Exam

After debulking, the specialized part begins. The doctor removes an outer layer of skin around where the tumor was located. This thin layer is mapped, frozen, sliced, and stained on slides. The Mohs surgeon examines these slides under a microscope, looking closely for any remaining cancer cells along the margins.

If cancer cells are still present, the surgeon maps their exact location and takes another tissue layer from that precise spot. This process repeats until no more cancer is seen under the microscope.

Closing the Wound

Once cancer is fully removed, the remaining defect can be closed using stitches or allowed to heal naturally. Sometimes reconstructive surgery is performed.

While the surgery itself takes 1-2 hours, waiting for lab processing and microscopic analysis of each layer extends the overall time to 4-6 hours.

After the Treatment: What is the Immediate Recovery Period Like After Mohs Surgery on the Scalp? 

The scalp will be tender, swollen, and bruised for a period of time after Mohs surgery. Here’s what to expect:

• Appearance: The scalp will look red and inflamed initially. Swelling and bruising may get worse for 2-3 days before improving.
• Healing Time: Small wounds usually heal within 2-4 weeks. Larger defects may take 4-6 weeks. Proper wound care speeds healing.
  
• Pain: Use acetaminophen or other over-the-counter pain relievers as directed to manage discomfort.
• Wound Care: Keep the area clean, moisturized, and protected according to your doctor’s instructions. Avoid picking scabs.
• Activity: Limit exercise and strenuous activity until healing begins, usually 2-3 days. Avoid anything that could hit or rub the scalp.
• Signs of Infection: Look for increased pain, swelling, oozing, redness, warmth, or fever and contact your doctor immediately.
  

What are the Long-Term Results of Mohs Surgery on the Scalp?

After recovery, the results of Mohs surgery on the scalp are generally positive:

• Scarring: Minimal scarring is expected. For larger areas, treatments like laser resurfacing can improve scar appearance.
• Hair Regrowth: Gradual hair regrowth is possible if follicles remain intact. However, extensive surgery may cause some permanent bald spots. Talk to your doctor about expectations.
• Cancer Eliminated: With Mohs surgery’s high cure rate, skin cancer recurrence is uncommon. But patients require lifelong monitoring.
• Sensation: Numbness or tingling can occur but typically resolves within a few months as nerve endings heal.
• Regular Activities: After healing, patients can resume normal activities like washing, combing, and styling the hair.
  

When Should I Consider Mohs Surgery for a Scalp Skin Cancer?

Mohs surgery is typically recommended for:

• Aggressive Skin Cancers: Basal cell carcinoma, squamous cell carcinoma, and melanoma may require Mohs if they grow rapidly, are large, or have concerning pathological features.
• Recurrent Cancers: Cancers that return after previous treatment often warrant Mohs surgery.
• Complex Areas: Lesions near eyes, ears, lips, or bony ridges are challenging to treat thoroughly, making Mohs a preferred option.
• Immunocompromised: Patients with weakened immune systems face higher skin cancer risks, for whom Mohs offers the best chance of long-term elimination.
  

Consult with your dermatologist or Mohs surgeon regarding the most appropriate treatment plan for your specific skin cancer.

Conclusion

Undergoing Mohs surgery, especially on a sensitive area like the scalp, can be anxiety-provoking. But this highly effective procedure allows doctors to precisely remove cancers while sparing surrounding tissues.

Healing from Mohs takes patience, but proper wound care and follow-up yields successful long-term results.

If Mohs surgery is recommended for your skin cancer, don’t hesitate to discuss all your questions with your doctor. Understanding the process and expected outcomes will help you feel informed and empowered.