Three years ago was the first time - of many - that I asked my dermatologist about a spot on my forehead. He's insisted the spot was a clogged oil gland. I recently asked if there's anything he can do since it's grown and I can't easily disguise it. Long story short, it's a basal cell and I need Mohs. 1. How many "passes" should I be prepared for? 2. Will I lose facial expression in my forehead? 3. My skin does NOT numb well. What are options for people who can't get numb?
Mohs & Basal Cell Questions. What To Expect From MOH Surgery?
Doctor Answers 4
What to expect from Mohs surgery
In answer to your questions:
1. Number of passes/ stages is not completely predictable although smaller tumors tend to require less stages. Our average number of stages is a bit less than 2 so most patients are clear with 1-2 stages, though it's just not perfectly predicable.
2. You would only lose facial expression in the forehead if either 1) the nerve to the forehead muscle is involved - this nerve is vulnerable mainly in the temple or 2) The removal of the cancer involves a fair amount of muscle. If the tumor is smaller, these possibilities are unlikely (maybe very unlikely) though you should ask your surgeon.
3. Mohs surgeons are very experienced at using local anesthesia. Just make sure that your surgeon knows that you are "hard" to numb so they can use all of their techniques. I have never had a patient in 15 years that we couldn't numb well.
Mohs and basal cell
It certainly cannot be predicted how many passes of Mohs you will require and it will depend on your doctor. Certainly, there is an excellent chance that you will NOT lose facial expression. If you aren't numb, ask the doctor to give additional numbing medication as the only alternative to this would be choosing a doctor who used general anesthesia which is probably not necessary.
Questions about Mohs surgery on the forehead
Mohs surgery is the best option to remove your basal cell cancer. This procedure is typically performed by a specially-trained dermatologist. It is impossible to determine how many stages of Mohs will be required until the margins are clear and the procedure is finished. With regard to losing movement in your forehead, this is highly unlikely but depends entirely upon the extent of the tumor. It is usually possible to completely anesthetize the area and you should not feel any discomfort after the anesthetic is injected into your skin. Many dermatologists perform beautiful reconstruction as well but some will refer you to a plastic surgeon for repair of the wound. I hope this helps answer your questions.
Stephen Weber MD, FACS
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Mohs Surgery: What to Expect
Mohs micrographic surgery provides the highest cure rate for skin cancer while preserving the greatest amount of surrounding normal healthy tissue.
My recommendation is to have your surgery performed by a Mohs surgeon who has completed a fellowship in Mohs surgery after their dermatology residency (i.e. a member or fellow of the American College of Mohs Surgery). The fellowship includes additional training in Mohs surgery, dermatopathology (interpretation of glass slides) and reconstruction.
It is impossible to say how many stages to expect. The point with Mohs surgery is that we start with the smallest surgical margin possible and then trace out the roots of the skin cancer. So if your skin cancer is very small, it will only be one or two stages. If your skin cancer is larger, then it could be additional stages. No guessing...only take a small rim of tissue and then examine the surgical margins.
Anesthesia is usually by local anesthesia since we don't know how many stages will be required. Talk to your surgeon about your concerns regarding anesthesia and he/she can try to make you as comfortable as possible. Good luck.