Comparing Numbing Techniques in Mohs Micrographic Surgery

This study seeks to determine whether adjunct regional nerve blocks reduce pain and anxiety in adult patients undergoing Mohs micrographic surgery for face and scalp skin cancers. Participants will be randomized to one of two arms: (1) placebo regional nerve block with sterile normal saline or (2) adjunct regional nerve block with lidocaine. All patients receive local infiltration with lidocaine for complete anesthesia.

Inclusion Criteria: * Age ≥18 years. * Scheduled to undergo MMS. * Lesions on the face or scalp, defined as the region superior to the mandibular margin anteriorly, superior to the external occipital protuberance posteriorly, and superior to the mastoid processes laterally. * Tumor diameter plus anticipated stage 1 MMS margin ≥2 cm in diameter OR any tumor on the ear, lip, nose, or eyelid. * Ability to complete patient reported outcome measures in English. Exclusion Criteria: * Known allergy or contraindication to lidocaine or epinephrine. * Chronic opioid use or pre existing pain disorders that may interfere with pain reporting. * Presence of scar tissue at the anatomic site of local infiltration or nerve block that may alter anesthetic penetration. * Concurrent multi site Mohs procedure. * Signs of skin and soft tissue infection at the anatomic site of local infiltration or nerve block. * Inability to understand or complete pain and satisfaction assessments. * Pregnant or breastfeeding. * Use of sedatives or anxiolytics prior to the procedure.