How would you manage a high risk SCC of the scalp that has wound healing issues after Mohs surgery?  

Refer the patient to plastic surgeon for wound repair. Indicate that the cancer is high risk for recurrence and warrants adjuvant RT (sooner rather than later), and that a vascularized reconstruction is preferable for that reason. In our experience, 60 Gy in 30 fractions is effective to prevent loca...

In our study, the only cases of local recurrences were after doses <60 Gy/30 fractions. We try to give this dose in most cases.