My Scalp is Still Numb 4 Weeks After Mohs Surgery is This Normal?

I had Mohs surgery 4 weeks ago and flap closure. My scalp is still very numb and I have scabs on my scars. how long will it take for things to improve

Doctor Answers 5

My scalp is still numb 4 weeks after Moh's Surgery - is this normal?

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Hello! Thank you for your question! Numbness after any surgical procedure is expected for several weeks to months following. As the nerves to the area are traumatized and will then experience a temporary neuropraxia, a transient loss of nerve conduction. This usually resolves over the next 6-12 weeks, but depending on the procedure performed, sometimes much longer. Typically this should resolve by 1 year. As it goes past this date, the likelihood of the sensation returning is small. However, it can take up to 2 years. If no return from there, it is unlikely to return. It should be discussed that persistent sensory changes may develop following any surgical procedure.

The usual signs of the nerves regenerating and neuropraxia resolving is itching, followed by a burning sensation and then occasional sharp, shock-like pains. These will be normal to experience, and actually a promising sign. Usually, normal sensation returns, but is is also possible to have decreased sensation or even increased sensation to the areas affected. Re-educating nerves postoperatively is often helpful and will allow proper instruction for the affected sensory nerves - methods include using different textures to the affected areas when showering, bathing, applying lotion, etc. If bothersome, there are some medications that may be helpful, including Neurontin for pain for hypersensitivity. You can try various textures such as washcloths, loofahs, cotton sheets, etc. Massaging the areas is also beneficial for the incision to make the finest scar possible. The last place to regain the sensation will be directly adjacent to the incision/scar as the nerves will make its way from the periphery to this location. If continual pain arises, evaluation is warranted. After ruling out other causes, one rare explanation may be that a neuroma has developed and may require surgical excision. This is very unlikely unless a large sensory nerve has been transected inadvertently during the procedure. Hope that this helps! Best wishes!

Numbness of scalp 4 weeks after surgery

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Numbness of the scalp is common for many weeks after surgery. It may take as long as 6 months for sensitivity to return.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

My Scalp is Still Numb 4 Weeks After Mohs Surgery is This Normal?

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I do a few 100 MOHs repairs every year. Many are in the scalp or forehead. My patients complain of numbness all the time. This is normal. There can be numbness in the scalp due to a sensory niece that runs in he forehead tissue. This nerve can be permanently injured due to the cancer removal or from the flap repair. Fortunately most of the time it is just a "bruised" nerve. It can take from 1-6 months to resolve. If it lasts beyond that some feeling may come back but most likely it will not. The scabs are normal as well.  These are areas either of delayed wound healing or scabs similar to when you skin your knee. They will fall off when the tissue beneath the scabs heal. You seem to progressing in a normal fashion.

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Scalp numbness after Mohs

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Your numbness is normal. In many instances depending upon the depth that the cancer was, some of the nerves may have been cut, which is causing the numbness. These nerves will regrow and rejoin, but it does take time. As for the scabs, if you can keep the area clean with 1/2 peroxide and water and keeping it free from scabs it would actually be better. I tell patients to keep any removal sites clean and free from scabs and to apply either Polysporin or Vaseline liberally to keep it moist. Scabs=scars, so keeping it moist and clean will actually help it heal faster and better.

Numbness after Mohs surgery

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It is perfectly normal to have numbness on the skin after Mohs surgery, even at 1 month post-op. If your surgery was performed on the forehead, the scalp adjacent to the surgical site might feel numb as well. In general, when you cut through the skin during the Mohs procedure, you often cut through the nerves in the skin as well. These nerves regrow, but they regrow extremely slowly. In some patients, it can take up to a year for the nerves to regrow and for this sensation to subside.

Adam J. Mamelak, MD
Austin Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.