Squamous cell carcinoma of the scalp (skin)

Welcome @cam108, I'm tagging fellow caregivers who have experience with squamous cell carcinoma of the scalp like @gaybinator and @sylviapf. They can share their experiences with you.

As you may know already, squamous cell carcinoma is the second most common type of skin cancer. It’s more common in people with fair skin and on areas of skin heavily exposed to the sun, including the scalp. Squamous cell cancer is generally very treatable and curable when found early. Mohs surgery is typically used when this type of cancer appears on the head or neck.

Cam, I can tell that you are very worried about your father and concerned about making the right choices considering his age and other conditions. I think you are asking all the right questions that you (and he) should discuss with his care team. I would ask questions like:
- What stage is the cancer?
- What is recovery from Mohs surgery like?
- Can the lesion be completely removed with surgery or are other treatments necessary?
- How many appointments will my father have?
- What will happen if he refuses treatment?
- How can he be kept comfortable and pain free?
- Is palliative care available?

What questions would you add? Do you accompany your father to his appointments?

I am 86, and just been diagnosed with the same thing. I would highly recommend your Father do the
Mohs surgery, as they can get the whole cancer in one surgery, and he will be cured. This would be a blessing
for him, and may give him a longer life.

Dan Kay

My dad had Mohs @ 96 . It is a one day deal, You will always question it if you don"t . I have had Mohs done myself as well as Melanoma

@cam108 my brother in law had it on his head and scalp (temples) the same thing and it’s very treatable. He’s doing just fine, he did end up having to have the MOHS about 5-6 different times and he’s great….stay out of the sun especially without sun screen!! That’s an order lol jk

MOHS is a one-shot treatment and I think he should not over "catastrophize" the surgery. It works, and it does not affect mobility or quality of life, more than several days, anyway. I live out in Arizona and the treatment is very common. Avoiding metathesis is the name of the game. And, it does not always require chemotherapy or radiation. I had MOHs for basal cell--in 1986 and it has not returned! https://www.hopkinsmedicine.org/health/conditions-and-diseases/mohs-surgery#:~:text=What%20is%20Mohs%20surgery%3F,only%20cancer%2Dfree%20tissue%20remains.

I went to my regular dermatologist in September 2022 with a suspicious sore on my scalp. She biopsied and reported it was squamous cell. She referred me to Metro Mohs for treatment. I called them but could not get an appointment until December--thinking I should act more quickly, I called Johns Hopkins since it is not too far from me, in Baltimore MD. My first visit to Hopkins was Nov 2, 2022. I pointed out a large red area around the bump and they subsequently took 7 biopsies, 3 of which came back as squamous cell. I was ready to do the Mohs thing right away. They said I was "very brave" and then they encouraged me to try the Efudex cream since there was such a large area involved, for 6 weeks.
On my next visit in January 23, Johns Hopkins redid biopsies and only one area remained squamous cell positive. They had me do the cream again and I opted to follow up with my regular dermatologist since it was closer. I visited her in Aug of 23 --she did a biopsy of the one original area and said it was negative. My last followup visit was in Oct 23--I mentioned the redness around the area is still there. She directed me to try the cream for 3 more weeks and did not do anymore biopsies. At this point, I am wondering what to do. So much time has gone by and I'm concerned about spreading. I don't know whether to go back to Johns Hopkins or try to find a dermatologist near my home who specializes in squamous cell (if there is such a dr.) I should mention I am autoimmune (with rheumatoid arthritis). Any advice or information is appreciated!

I had squamous cell on my face size of a silver dollar. After 3-4 times going back in during the MOHS they got it all. That was quite a few years ago I would definitely go back to John Hopkins or a major hospital like them, Mayo etc. and I’d continue to be followed by them. Since my squamous I’ve had 3 Basal and a Melonoma insitu. All is good, none spread internally but that’s just be a I’m being followed by major University. My dermatologist was freezing the melonoma thinking. It was nothing.

@nancyj21 Welcome to Mayo Clinic Connect. I am glad to hear your melanoma was finally addressed. That was my situation, also, with melanoma. Three doctors dismissed it as a "rash", before I paid out-of-pocket for a biopsy. It was amelanotic, meaning no discernible color, which is not a common finding. I now sport a 32-stitch scar on my right forearm from the surgery, that was in 2008.
Ginger

Nancy, Thank you so much for taking the time to respond! I think you are right--I should go back to Johns Hopkins--although I was a little disappointed in them at first for having me try the cream. I think I need to get it taken care of sooner than later, even though I'll be half bald when it's over. Thanks again for weighing in.
Frankie

Wow that is terrible that many dismissed it! Glad you followed your instincts . They should have to reimburse you once they found out what it was!