Which type of surgeon removes scalp masses?

Types of Surgeons Who Remove Scalp Masses

Neurosurgeons and dermatologic surgeons are the primary specialists who remove scalp masses, with the specific choice depending on the depth, location, and suspected pathology of the mass.

Determining the Appropriate Surgeon

The selection of surgeon depends on several key factors:

Based on Mass Characteristics

• Superficial scalp masses (confined to skin and subcutaneous tissue) are typically managed by:

  • Dermatologic surgeons 1
  • General surgeons with experience in skin lesions 2
  • Plastic surgeons (especially when cosmetic outcome is important) 1

• Deep scalp masses involving or adjacent to the skull require:

  • Neurosurgeons (particularly for masses with potential intracranial extension) 3, 4
  • Skull base surgeons for complex cases near the base of the skull 3

Based on Suspected Pathology

• Benign lesions (dermoid cysts, epidermoid cysts, lipomas):

  • Can often be managed by dermatologic surgeons or general surgeons 4
  • Comprise approximately 33% of scalp masses 2

• Malignant lesions (67% of scalp masses in some series):

  • Primary skin cancers: Dermatologic surgeons, surgical oncologists 2
  • Metastatic tumors: May require neurosurgical involvement, especially if bone invasion is present 2, 5
  • Skull base tumors: Require specialized skull base surgeons, often with a multidisciplinary team 3

Surgical Approaches and Considerations

• For superficial masses:

  • Excisional biopsy with appropriate margins is typically performed 1
  • Incisions should be planned to spare neurovascular structures and follow skin tension lines 1

• For deep masses involving skull:

  • More extensive preoperative imaging (MRI, CT) is required 5
  • May require wider surgical margins and potential skull reconstruction 3
  • En bloc resection is preferred when feasible 3

Special Considerations

• Vascular lesions of the scalp may require preoperative embolization to reduce bleeding risk 3

• Malignant scalp masses are often more aggressive than similar lesions elsewhere in the body and may require a multidisciplinary approach 5

• Pediatric scalp masses present a unique spectrum of pathology and are typically managed by pediatric neurosurgeons or pediatric surgeons 4

• Fine-needle aspiration can be used for initial diagnosis of scalp masses, especially when metastatic disease is suspected 2

Common Pitfalls

• Underestimating the extent of scalp masses can lead to incomplete resection and recurrence 5

• Inadequate preoperative imaging may miss bone involvement or intracranial extension 5

• Poor incision planning can lead to complications including alopecia, wound dehiscence, and poor cosmetic outcomes 1

• Excessive blood loss is a potential complication, particularly with vascular lesions or large tumors 3