Mohs and Plastic Surgery for a Basal Cell Carcinoma on the Right Nostril*

Procedure Details

This 79 yo male was referred for a basal cell carcinoma on the lateral nasal ala (nostril) of the nose. The patient stated that it had been growing for approximately 6 months before the biopsy was performed by his dermatologist. Mohs surgery was utilized to remove the skin. Although the skin cancer looked small on the surface, only measuring 0.8 x 0.7 cms., the microscopic roots extended even further. Complete clearance of the cancer required 3 stages of Mohs surgery to remove all roots and the final size was 1.4 x 1.3 cms. The final defect extended from the nostril onto a small portion of the cheek and a small portion of the nasal sidewall. Since the skin cancer was not completely contained within the boundaries of the nostril, the reconstructive process more difficult. Because of the location and size of the hole, repair was performed using a two-stage approach, first closing the defect with a type of skin flap ("adjacent tissue transfer") called a nasolabial flap. The patient bandaged the area at home for one week until sutures were removed. Several weeks later the patient underwent a second small procedure to deepen the natural crease above the nostril and achieve great symmetry compared to the other side. The patient is happy with the results as the shape and direction of his nose were not altered and the scar is hidden along the normal creases of the skin.
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Nasolabial Flaps

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.

Location

Skin Cancer Consultants

*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.