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Mohs Case For May: Excision on the Scalp

A 72 year-old female patient, presented to our office for treatment of a recurrent infiltrative basal cell carcinoma of her forehead.  According to the patient, surgery had been attempted twice previously.  Neither attempt yielded clear margins and the tumor recurred.  As noted in previous blogs, this type of basal cell carcinoma is typically more aggressive than a standard nodular basal cell carcinoma and is frequently larger than it appears to be.  This is why it is difficult to obtain clear margins with standard surgery.

Figure 1

Three stages of Mohs micrographic surgery were required to clear the tumor.  The final defect involved a significant portion of the patient’s forehead (Figure 1).  Luckily, the bone was not involved. 


Several closure options were reviewed with the patient.  Grafting was discussed, but she and her husband had significant concerns regarding the look of a graft, especially on the center of the forehead.  Ultimately, the patient opted for a bilateral advancement flap.  This flap had the advantage of being performed in a single stage while yielding a cosmetically pleasing result.  Tissue from the lateral aspects of the forehead were elevated and moved (advanced) centrally (Figure 2).  The left side of the patient’s forehead was also rotated slightly to achieve the proper positioning.  This allowed for complete closure of the wound while keeping the patient’s eyebrows level and even.

Figure 2

The sutures were removed after one week of healing (Figure 3).  The patient was extremely happy with the results and had no complications during the course of her healing.

Figure 3


This case is presented to demonstrate the severity of skin cancer, even non-melanoma skin cancers, and to highlight the skill of Pine Belt Dermatology & Skin Cancer Center in managing complex skin cancers. All of our providers take a holistic approach to treating skin cancers and pre-cancers. Our Mohs surgeon, Dr. David Roy is the only Board Certified Mohs Surgeon in the Hattiesburg, Mississippi area. Many of our competitors in the area focus on cosmetic dermatology and treatment of mild skin cancers, but our niche is management of chronic skin conditions and complex skin cancers. If you or a loved one has been diagnosed with skin cancer, there is no better dermatology group to manage it than Pine Belt Dermatology.


Skin cancer is the most commonly diagnosed cancer each year, and the Pinebelt area is significantly at risk for development due to the large agriculture and manufacturing industries in our area. May is Skin Cancer Awareness Month. Healthcare providers, even those not in the field of dermatology, will be working diligently to educate the public on the risks of skin cancer and will be urging the public to get themselves screened annually. In fact, Kristen Richardson will be hosting a “Melanoma Monday” screening on May 20th, from 9:00AM-12:00PM, at our Hattiesburg clinic in the Merit Health Wesley hospital. This skin cancer screening is free and we encourage everyone to come by. You can get yourself booked for the screening by calling 601-475-9968!

Dr. David Roy Lead Pine Belt Dermatology Physician

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