Waiting Too Long for Mohs Surgery?

Mohs Micrographic surgery is indicated for nonmelanoma skin cancers (NMSC) such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on cosmetically sensitive areas of face, neck, and hands as well as NMSC larger than 2cm and NMSC with aggressive pathology. While BCC can be more indolent and takes several months to develop, certain SCC can be somewhat more aggressive and should be taken care of in matter of few to several weeks and not months.

Definitely get the consultation with the Mohs surgeon.The answer to your question may be derived from looking at the actual biopsy slides, not just the report, and this can be done by the dermatologist who did the biopsy or the Mohs surgeon who will see you. The doctor could call the dermatopathologist to get a better idea of the urgency of treatment. If it is a thin or superficially invasive SCC your doctors might feel more comfortable to wait than if it were more invasive. Please realize that some SCCs are more aggressive in their growth pattern when it is on the scalp, but if it is an in-situ, or just the beginning of an SCC, then the wait is less of a concern.

A well differentiated SCC on an otherwise healthy person is not a high risk lesion. Most of these arise from actinic keratoses, and although they need to be removed, waiting for a week or two for an excision is not an issue.

I dont know the size of the spot they biopsied, but in all probability, your doc will be able to have the site closed and it will heal nicely and your hair won't be an issue.

 

I would definitely contact the Mohs surgeon and try to get in sooner. If that doesn't work, your referring doctor can make the call. Aside from concerns about the potential risks or agressiveness of this kind of cancer, you are particularly concerned about it. If a patient or referring doctor is particularly concerned, we'll see the patient right away. That way if appropriate we can put their concerns at ease or try to schedule them sooner. Regarding squamous cell carcinomas on the scalp, these can be more agressive or difficult to treat so an earlier consultation is a good idea from this standpoint.

The most common tumor treated with Mohs surgery is basal cell carcinoma. This is typically slow-growing (over months to years) and has nearly no chance of spread to distant parts of the body. For BCC, therefore, a wait of a few weeks for treatment is likely to have no or minimal impact on outcome. Squamous Cell Carcinoma (SCC) can also be slow-growing but in some cases can grow quickly and spread beyond the skin. As a general rule, I try and see patients with an obviously growing SCC within 1-2 weeks and try and arrange the surgery if posssible in that time frame as well if the lesion is actively growing or has other concerning pathologic features. If the lesion has been present for many months or even years and is clearly growing slowly there is likely less urgency. In a case like yours if there is any evidence of growth, I would encourage being seen relatively soon to minimize the size of the defect and surgery needed.

Squamous cell carcinomas of the head and neck are considered higher risk tumors as compared to other locations with the same histology. However, the differentiated nature of the tumor upon biopsy will help your dermatologist grade this tumor and understand it's aggressiveness. Treatment of more aggressive or more high risk tumors should be performed sooner than later.

2 months is toward the upper limit of the length of time I would want to wait to treat an invasive squamous cell skin cancer on the scalp, depending on the size of the tumor and the histology (appearance under the microscope). I would consider consulting with another qualified practitioner in the area to see if you can get in sooner. Consider searching www.aad.org for dermatologists in the area. If it is a plastic surgeon you are looking for to close the wound, the dermatologists in your area should also be able to direct you in that regard.
Good luck.