Can the Moh's surgery on this cancerous place on my scalp be done with a local anesthetic that does not contain epinephrine?

The short answer is that epinephrine is not necessary for local anesthesia. However, there are two reasons that it is extremely beneficial. It helps control bleeding and it allows the numbing to last longer. Make sure to discuss the reasons you would like to avoid epinephrine with your doctor. I have treated scalp lesions without epinephrine but it always takes a little longer and it is sometimes more difficult to keep the area completely numb. True epinephrine allergies are extremely rare since it is a chemical that the body makes naturally and that is required for normal body functioning.

The use of lidocaine with Epi during Mohs surgery is optimal, especially in areas where bleeding can be excessive (like the scalp) because the epinephrine causes vasoconstriction and minimizes bleeding.  It is very advantageous to minimize bleeding as it allows the surgeon to see more clearly and be able to cut and suture in a more meticulous way.  Some patients are sensitive to the Epi and it can make them feel like their heart is racing, however, the small amount that is used in Mohs surgery is not typically problematic and contributes greatly to a smooth and uneventful surgery.

Thanks for your question. The epinephrine in local anesthesia acts to 1) stop bleeding 2) reduce diffusion of the lidocaine.  Most surgeons prefer to use epinephrine in the scalp because the scalp is highly vascular. Anything is possible, but I would discuss this question with your surgeon before you start Mohs. Best of luck.