Basal Cell Carcinoma of Frontal Scalp. Pending Moh's Surgery. Had It 2x Before. Is This the Best Option?

Path. Report states: "islands of basaloid epithelium, characteriszed by peripheral palisading and single cell necrosis. .. Associated mucinous stromal alteration" What subclass is bcc? Help me determine best course for removal and cosmetic effect. (don't want bald spot) The tumor appeared suddenly, is about 2-3 cm. crusting, bleeds, scab...I have a history of basal and squamos cell...on face... and front chest. Family history too. Thanks for your help. Mag

Doctor Answers 3

Mohs is absolutely indicated in a recurrent lesion on the scalp

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Mohs is definitely indicated here.  The pathology report does not indicate any thing more dangerous but the simple fact you have had two recurrences means the BCC needs more careful microscopic control of margins and this is where Mohs excels.  Focus on the removal of the tumor first.  Repairs come second.  Often in large scalp cases your Mohs surgeon may get involved with a facial plastics or plastic surgeon to assist in closure.  The scalp is pretty foregiving and you can usually come up with a repair where the remaining hair and hairline are well approximated.  Remember, first things first!

Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Basal cell on scalp #skincancer

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I do a few hundred of these closures a year for various Dermatologists here in Arizona. I can tell you that it is very unpredictable as to how big of an area will need to be removed. I do believe that for skin cancer in the head and neck area Mohs does offer the best choice for preserving skin for closure. Being that said, the scalp is very unforgiving and no surgeon could ever promise you that you will not lose an area of hair. It also depends on if the defect goes down to bone or not. Again, no way to know until the Mohs surgeon starts removing it. There are options down the road if you do have an area of non-hair bearing scalp. Make sure you consult with your Mohs surgeon for some of the other issues you are concerned about like type etc...They are the best for that kind of advice. All it really means for you is how aggressive the BCC is. If this is a recurrence it likely is a little more aggressive. There are non-surgical options like radiation but only you and your Dermatologist can decide if that is the best route. I hate radiation!!!!

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Reconstruction of Forehead Cancer Defect / Mohs Defect.

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Sounds like Moh's surgery is a great option for you for the best chance at complete resection the first time. Closure by a board certified plastic surgeon would be important as the defect may be large.

The forehead is a great donor site in skin cancer reconstruction of the face however when the forehead is involved the closure can be a bit more difficult. A skin graft is always an option but a A to T flap can provide an excellent result. To get the kind of movement you need general anesthesia is often needed. With proper planning a good result is very possible.

Best of luck!


W. Thomas McClellan, MD, FACS
Morgantown Plastic Surgeon

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