Mohs Surgery for Advanced Tumors of the Scalp

Abstract

BACKGROUND The scalp presents unique surgical challenges, and specialized techniques are sometimes required to achieve optimal results. Tumors arising on the scalp may also be at increased risk of complications such as in-transit metastasis and perineural invasion. OBJECTIVE To review challenges to Mohs micrographic surgery on the scalp and techniques for successful tumor extirpation and reconstruction. METHODS AND MATERIALS This article reviews our experience with tumors of the scalp including techniques that we have found helpful both for tumor removal and for reconstruction. CONCLUSION Familiarity with the anatomy of the scalp as well as common challenges encountered during Mohs surgery may help improve outcomes and impart increase confidence to the practicing surgeon.

Basal cell carcinoma of the scalp shows distinct features from the face in Asians

“…Thus, although our data showed that the proportion of high-risk BCC was lower in scalp BCC than that of facial BCC, it was unable to clearly discuss the actual prognosis of scalp BCC. However, our study emphasizes that the scalp requires a thorough physical examination as an earlier onset of BCC and hair coverage could result in late detection of lesions, and larger tumor size would cause difficulty in surgery due to the tightness and lack of surrounding reservoir tissue in the scalp 27 . Moreover, our study is meaningful in that we analyzed the characteristics of a large number of scalp BCC patients in the non-Caucasian population.…”

Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches

“…This could be explained to the chronical sun-exposure of the scalp and the protective role of the hair, scarcer in men due to common male baldness and to cultural preferences (i.e., shorter hair for men) [5,12,32]. Some authors have supported the inclusion of the scalp as a high-risk location, as it is associated with worse prognosis [31,33,34], including a risk of local recurrence of 6-10% [32,35,36], and a 7-9% risk of lymph node metastasis [32,33].…”

“…The galea aponeurotica is a firmer layer of the scalp and i tinuous with the frontalis muscle anteriorly, the occipitalis muscle posteriorly, an temporoparietal fascia laterally. The skull beneath the scalp is composed of separa nial bones-frontal, temporal, parietal, and occipital bones-which are used to vir divide the scalp into sections [31,34,37]. This unique anatomical structure may influence both behavior and treatment primary tumors of the scalp.…”

“…When beginning any scalp procedure, it is important to properly prepare the surgical field. Shaving the hair of the affected area up to at least 1 cm from the suture margin-if applicable-and using a towel wrap, or cutting or pinning down perilesional hair with clips or tape, may prevent the introduction of foreign bodies into the wound [34,60].…”

“…It must be considered that the scalp is supplied by a rich network of anastomosing arteries within the subcutaneous layer, which are fixed to fibrous septa and often bleed profusely during surgery (Figure 1). In this regard, allowing at least 10 min between the injection of lidocaine with epinephrine and the first incision may provide better visualization and hemostasis during the surgery, facilitating the procedure and the identification of tissue planes and vulnerable structures [34]. In addition, the use of tumescent local anesthesia may also facilitate the procedure, expanding and allowing easier plane dissection with lower risk of bleeding [34,61].…”