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

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

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.

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.

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.