Mohs surgery and reconstruction: What timeline to expect?

Posted by keithl56 @keithl56, May 13 6:01am

I have been diagnosed with squamous cell carcinoma on my head. My dermatologist set up a consult with a surgeon that does Moh's surgery on 5/29 and a consult with a reconstructive surgeon on 6/10.

Can anyone provide information regarding the usual time between consult and surgery and the time between Moh's and reconstruction?

I just had a large basal cell lesion surgically removed from back last May and am not looking forward to this summer!

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You may not have a realistic answer until you see the Mohs surgeon. Your derm has followed their usual protocol assuming you need reconstructive follow up.
The Mohs surgeon deals with the size, location and extent of the squamous cell. The frozen sections they
evaluate and what they need to consider for control
of any bleeding will be a factor.The Mohs surgeon
likely has their routine established with the plastic surgeon and can communicate with pictures for planning.
Some areas on the scalp will heal with secondary intention and are suitable for gradual healing without closure.
Pathology exam will also indicate how much follow up care required.
Follow your preop instructions especially with regard to
any medication or supplements that could affect bleeding and you should do well. Understandably you are a bit apprehensive and want to plan for the best results.

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@seniormed

You may not have a realistic answer until you see the Mohs surgeon. Your derm has followed their usual protocol assuming you need reconstructive follow up.
The Mohs surgeon deals with the size, location and extent of the squamous cell. The frozen sections they
evaluate and what they need to consider for control
of any bleeding will be a factor.The Mohs surgeon
likely has their routine established with the plastic surgeon and can communicate with pictures for planning.
Some areas on the scalp will heal with secondary intention and are suitable for gradual healing without closure.
Pathology exam will also indicate how much follow up care required.
Follow your preop instructions especially with regard to
any medication or supplements that could affect bleeding and you should do well. Understandably you are a bit apprehensive and want to plan for the best results.

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Also, I appreciate your comments regarding preop instructions and bleeding. When they surgically removed the large basal cell from my back last year they advised to stop my aspirin 10 days prior to surgery. However, my neurologist and cardiologist would only agree to a 5 day stoppage. As a result, they had to cauterize quite a bit during surgery to control the bleeding. I would think that this surgery would be more problematic since if they are going to do reconstruction they have to preserve blood flow to the area so that the flap has adequate blood flow post surgery. Definitely an issue to discuss during my consult.

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I had Mohs surgery on my cheek about two years ago.
I applied Scar Away daily for three months. My face really looks quite smooth now from the application.

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Thanks! Besides scarring my other concern is that I'm concerned that it may affect my hairline based on the location of the cancer.

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I just put in a long post about my scc's. the one on my hairline was a huge opening with long cuts so that it could be closed to heal smoothly. It always suprises me how relatively painless the recovery is compared to how it looks. My dermo MOHS surgeon at Mayo did an excellent job even though it required 6 passes to get it all. Took 3 months to close up enough for 20 radiation treatments. It was red for a few weeks and now almost a year later, not noticeable. My hairline is actually straighter than it was although my forehead a big higher. I'm pleased and thrilled at what was done.

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@louisejewell

I just put in a long post about my scc's. the one on my hairline was a huge opening with long cuts so that it could be closed to heal smoothly. It always suprises me how relatively painless the recovery is compared to how it looks. My dermo MOHS surgeon at Mayo did an excellent job even though it required 6 passes to get it all. Took 3 months to close up enough for 20 radiation treatments. It was red for a few weeks and now almost a year later, not noticeable. My hairline is actually straighter than it was although my forehead a big higher. I'm pleased and thrilled at what was done.

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You are very lucky. My lip and nose surgery done in Feb, is still looks quite obvious and feels "tight" and very hard. I can't exactly describe the sensation. Half of my lip is pulled down into my mouth. My nose runs all the time.
Now I think there is another cancer on the other side of my mouth, and for obvious reasons I am dreading yet another trip to the dermatologist. It never ends, as I have had numerous Moh's surgeries.

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Hello @keithl56 . I just had my elderly aunt to the surgeon for her Mohs procedure on her scalp on top of her head. It was quite superficial in the biopsy and we waited 3 months for an appointment for the surgery. It was removed in the first pass and instruction is to allow for granulation to heal this over the next 6-8 weeks. It is kept covered with antibiotic ointment and gauze and has been quite painless for her. With a 3 cm round area now open, there was no way to bring scalp edges together. At age 97, reconstructive surgery was not mentioned.
The scalp is a very vascular area so significant cautery was used to control bleeding. Granulation tissue is very vascular also so I am not concerned about blood supply for healing. Good luck to you.

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Thanks for the info.

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@mermaid7272

You are very lucky. My lip and nose surgery done in Feb, is still looks quite obvious and feels "tight" and very hard. I can't exactly describe the sensation. Half of my lip is pulled down into my mouth. My nose runs all the time.
Now I think there is another cancer on the other side of my mouth, and for obvious reasons I am dreading yet another trip to the dermatologist. It never ends, as I have had numerous Moh's surgeries.

Jump to this post

Hello I had squamous cancer on my bottom lip, which was cut out back in 2007. I lost pretty much my whole lower lip and a portion below my lip too. They did a graf and flap to help with movement and actually they put too much tissue in the place where they removed my lip and it's real puffy. Almost looks like I'm chewing tobacco. Embarrassing and deformed since then. I was always told there wasn't anything they could do because they now refer to it as being cosmetic. I guess that means I would have to pay out of pocket to try to look more normal.. such a terrible thing to be told. I live my life indoors or looking down all the time. Not how anyone should be. Recently someone asked how come insurance will pay for a woman to have breast implants after she had hers removed due to cancer. I was shocked. I feel our faces is the first thing that everyone sees so I would think our faces would be covered..

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