Mohs and Plastic Surgery for a Basal Cell Carcinoma on the Right Nostril*
Basal Cell Cancer Alar Nose
On preoperative examination the visible basal cell cancer only measured 0.8 x 0.7 cms. however, the underlying microscopic roots were more extensive as is common with many skin cancers. Complete removal required 3 stages of Mohs surgery and the final size was 1.4 x 1.3 cms. Despite the extensive nature of his cancer, the cure rate with Mohs surgery is 99%. More
Closure with 2 Suture Layers
The scar on the cheek is nicely hidden along the nasolabial crease and is almost imperceptible after healing in many patients. There are two layers of stitches. The underlying stitches cannot be seen in this picture because they are deeper below the surface. They will dissolve on their own. The top layer of sutures are the visible blue sutures and they are removed in approximately 1 week. If sutures are left in the surface too long, a "railroad track" type of scarring can occur. If sutures are taken out too early then some scars can spread and widen. With strong supporting stitches in the deep layer, removing top stitches 1 week after surgery usually yields the optimal result. After top stitch removal we often reinforce the healing skin by placing steristrips across the surface. These are like small pieces of reinforced tape that usually stay on for about one week and provide a little more support for optimal scar healing. More
Before and After Photos of BCC
Patient is healing well post Mohs micrographic surgery and reconstruction of the right nostril. More
The are different variations of the nasolabial flap. Often plastic surgeons will perform a "pedicled nasolabial flap" designed as an "interpolation flap". This is the classic way that nasolabial flaps have been performed over the years. An area with skin redundancy or laxity is cut like a peninsula, lifted up and then bridged over normal skin to reach the cancer defect where the distant end of the peninsula is inserted and sutured to fill the cancer hole. However, in this patient we performed a different variation called a "nasolabial transposition flap". The transposition flap allows the skin to be shifted over into the defect without having a bridge of skin hanging over normal skin. When possible, avoidance of the skin bridge allows for easier healing, immediate aesthetic advantages, and much easier after-care. The skin bridges usually have raw undersurfaces that can bleed and ooze and make aftercare much more tedious. The skin bridge is also very unsightly for the few weeks it is in place. Last, skin bridges almost always require a second procedure weeks later to remove the skin bridge and “inset” the flap. Transposition flaps sometimes require a second procedure as well, but it is typically a much simpler procedure. Ultimately, we usually choose the procedure that will give the best long term result. But, in cases where the results should be similar either way, we lean toward transposition flaps instead of interpolation flaps.
*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.