Scalp Reconstruction after Mohs Cancer Excision: Lessons Learned from More Than 900 Consecutive Cases

Area of Science:

• Plastic Surgery
• Dermatology
• Oncology

Background:

• The scalp's large surface area and sun exposure increase skin cancer risk.
• Resection of scalp cancers frequently results in large, complex defects requiring reconstruction.
• Over 10 years of experience inform objective data and recommendations for scalp reconstruction.

Purpose of the Study:

• To present objective data and recommendations for scalp reconstruction.
• To describe various reconstruction methods and propose an algorithm.
• To analyze outcomes of over 900 scalp reconstructions.

Main Methods:

• Retrospective review of patients undergoing scalp reconstruction post-Mohs surgery.
• Evaluation of patient characteristics, defect details, and reconstructive techniques.
• Analysis of complications over a 10-year period.

Main Results:

• 913 scalp reconstruction procedures were performed by the senior author.
• Defects commonly occurred on the forehead or vertex, varying in size.
• Adjacent tissue transfer and Integra dermal regeneration templates were primary methods.
• A 12.5% complication rate was observed, including graft loss and recurrence.

Conclusions:

• Scalp defect reconstruction requires consideration of patient and defect variables.
• A tailored plan based on defect composition and patient needs is crucial.
• Outpatient scalp reconstruction is a safe option, even for elderly patients.