My Story – Basal Cell Carcinoma of the Scalp: Bye-Bye Basal Cell & Baby Shampoo

Posted on by Pamela M. Bond Contractor

Always Wear a Hat_50%  Hats Are Hot on Chicks—Little & Big

As described in the January 1 and January 2, 2014 posts, two weeks ago, on December 30, 2013, the basal cell carcinoma in the part line of my scalp was excised using Mohs micrographic surgery (see the November 21, 2013 post). Yes, what I said before is true: after having a total robot-assisted laparoscopic hysterectomy for uterine (endometrial) cancer, I can honestly say that removal of this little pink spot on my scalp caused me very much more pain than having my reproductive organs yanked out through six tiny incisions. I told my gynecologic oncologist that I’d have a hysterectomy again any day before I’d have another scalp lesion removed because of the different in post-op pain. He just sort of stared at me. But I meant it.

Today, I returned to have the stitches removed. The dermatologic surgeon had originally said he would use royal-blue suture material to be sure the stitches would stand out at the time of removal, but for some reason he changed his mind and used black Ethilon. I was braced for more pain in this super-tender area, which still had some scabbing.  But when the nurse took the stitches out  (five–I counted), I am happy to report that it wasn’t bad at all–very quick and easy. At the time of surgery, the nurse said I would feel “a pinch and a tug” when the stitches came out, which was pretty much true, with only a small twinge or two. She had also said they don’t give numbing injections for suture removal because the lidocaine hurts more than taking  the stitches out. That is definitely the case–lidocaine injected into the skin burns like hellfire, although for some reason it doesn’t burn like that when it is injected into your mouth before a dental procedure.

The image on the left shows the area where the basal cell carcinoma was removed from my left frontal scalp; the image on the right (which I do not think is me–it’s probably a generic photo) shows the surgical area after it wasMohs Scalp Excision & Repair_Images_2013-12-30 sutured crosswise. It’s a little hard even for me to orient myself in the photos, but if you looked at me in person, you’d see a horizontal scab crossing my high-left-sided part line at the very front of my scalp, almost touching my forehead. Now that the stitches are out, I’m looking forward to using regular shampoo–and conditioner!–again. And, of course, I’ll be using sunscreen in my part line, which may be a bit wider than usual while a few hairs grow back.

Looking back on it, I believe I had a reaction to the lidocaine at the time of surgery. I fell asleep when I got home, which I hadn’t expected, and my laparoscopic incisions itched. These symptoms wore off by the next day, but that’s when the burning, pulling pain started in earnest as the anesthetic started to wear off. This burning pain lasted for about four days. I told the surgeon about it today, and also told him that I had taken narcotic pain meds that hadn’t helped. He said hot burning pain like that indicates nerve involvement and that a nerve could have been caught in a stitch. Had I called him, which I hadn’t because it was New Year’s Eve and New Year’s Day when I was in the most pain, he would have prescribed a pain medication used for seizures, such as Neurontin (gabapentin), because typical narcotic analgesics don’t work for nerve pain. He also said I was fortunate that the pain wore off in a few days–sometimes it lasts two to three weeks! Now, just before bedtime, I can say that although the previous burning nerve pain is almost gone, the nerves must have been disrupted by the suture removal this morning, and I have some sensitivity–especially when I touch the area. So I guess it will be a while before I can get my very graying hair colored–the skin is just not ready for anything that irritating.

So although I didn’t start the new year feeling very good, I did start it cancer free. And I have learned my lesson about letting things go–I first noticed this pink spot two or three years ago and didn’t have it checked. It didn’t start to bother me until this past summer, when it started to itch and deepened in color a bit. In retrospect, I should have gone to the dermatologist within weeks of first noticing it. And despite the fact that I have never liked wearing things on my head or in my hair, I will now learn to love hats–and I have a newfound respect for sunscreen.

Because we were so focused on discussing my pain today, the doctor and I never got around to talking about sun protection. But common sense will prevail, and I will start using my facial moisturizer with sunscreen in the area of my part line as soon as the skin is less tender. Here are three “drug-store” facial moisturizers in descending SPF (sunprotection factor) value that you may wish to try:

You can find many more products on the web for different skin types, and some are tinted so you wouldn’t have to use foundation (if you do).

But whatever you do, please take a word to the wise and protect your delicate skin from the sun–especially on your head. You really don’t want to know what it feels like to be scalped.

13 thoughts on “My Story – Basal Cell Carcinoma of the Scalp: Bye-Bye Basal Cell & Baby Shampoo”

  2. Having the Mohs done on my scalp on Tuesday. I found this while googling info about what to expect – especially about pain. Mine is rather large so I’m hoping I can handle the pain. Thanks for sharing your experience!

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    1. Hi, Katrina.

      It’s a little hard finding complete information about patients’ experiences with Mohs, isn’t it–at least it was when I was searching last winter.

      The most important advice I can give you is to ask your surgeon about the proper pain medication. As I described above, narcotics didn’t help me–although, interestingly, Tylenol did offer some relief (but can be toxic at high doses). I suggest you ask about a drug such as Neurontin ahead of time so you’re prepared in case you experience burning pain, as I did.

      It was also interesting to me that I was able to wash my hair almost immediately, and this is a good thing to do–the baby shampoo doesn’t do much for the hair itself, but it does help remove the caked blood. Just pat it on gently with your fingertips and rinse with warm water from your cupped hand. As my scab gradually fell away, so did the hair beneath it. The surgeon hadn’t cut any hair away before the procedure–I thought that was a little odd.

      Six months later, the hair is growing back–gray, unfortunately! But I can get it colored again. I am parting my hair on the other side now and use a dab of sunscreen in my part line. I have no discomfort or signs of recurrence. But because the scalp has very little subcutaneous tissue, I do have a “dent” in my head that you can feel (but can’t really see).

      Best wishes for an easy procedure and a quick recovery. Please let me know how you make out next week.

      Pam

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  3. I had exact procedure as you in April. It itched and tugged for weeks as it healed. And healed well, by the way. But the past couple of weeks it’s been tugging and I feel pressure, driving me nuts. I’m seeing my dermatogist tomorrow. It’s made me scared. I’m looking to see if this is normal or nuts! Glad you have overcome the scary “c” word.”

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    1. Dear Jacquelyn,

      Please let me know what your dermatologist said about your continuing discomfort. I’m not an expert, but it sounds like nerve pain or damage. If so, I hope it will heal in a short time.

      Thanks for writing. It feels great to overcome cancer in any form! I was surprised at having to deal with two at once (scalp and uterus), but I’m doing well now.

      Good luck, and please keep me updated.

      Pamela

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      1. Well, I saw my doctor Friday and he said those pains were scar tissue, as the wound which I’ve treated with homeopathic solutions was healed up beautifully. If there was anything cancerous of the “tumor” on my scalp, he would be able to see it with the naked eye. The patterning of the healing process and all fell on to scar tissue beneath the surface which does make sense. The LAPSE of weeks without pain and then pressure returning was what was scary to me. All is well!

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      2. Thanks for updating me, Jacquelyn.

        It is unusual to have those sensations after a lapse of time, but I’m very glad to hear they don’t worry your doctor. These feelings probably are a sign of continued healing deep into the nerves.

        One thing: As I understand Mohs surgery (if that’s what you had, as I did), microscopic examination of thin layers of tissue are required to detect cancerous cells. However, your doctor’s experienced eye and skill may enable him to tell what’s going on just by looking.

        In any case, you seem to be doing very well. Happy to hear it!

        Wishing you continued good health,

        Pamela

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    2. For clarification, cancerous tissue was detected by its appearance on my scalp as well as itching and occasionally slight bleeding. Yes it was MOHs surgery I had. And doc said it would not be a healthy piece of flesh there, it would be messy if cancerous tissue was missed. Makes sense.

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      1. My early symptoms were also visible–a pink spot on my scalp for several years–and I also had itching and slight bleeding just before I was biopsied. Fortunately, my Mohs procedure required only one “slice” with the specimen showing clean margins under the microscope. Yet this small procedure left a large dent in my head!

        But I’m glad we both got a good result in terms of “no more cancer.”

        Best wishes for continued good health.

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  4. I just came across this post. I had Mohs surgery just like you on my scalp and its about the size of a oversized quarter. I had extreme pain as well, I took extra strength tylenol round the clock and had an icepack on it around the clock for 5 days the pain was about as bad as my two knee replacements. I called and called and never got anyone to pick up at the docs office or the number they gave me to call the surgeon on call. Finally on day 7(!) someone called me back. I am at day 14 now and still some pain and itching so its healing. Luckily I am a RN so I could tell there was no infection or I would have gone to the ER or urgent care. I am really dismayed at the lack of folllow up from the office. I did read where possibly lidocaine jelly could have been prescribed. I hope I never have to have this again, but if I do I will ask for he Neurontin and the Lidocaine jelly.

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    1. Hi, Gina. I believe it was about a year after the surgery. I was nervous, but it didn’t hurt at all or even sting, and I had no problems. For several years, I parted my hair on the other side, but I could never get used to it. Now, I am sort of “partless” and “tousled,” but my hair more or less keeps the surgical area covered. Best wishes, Pamela

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