Journal of Aesthetic & Reconstructive Surgery

Comparison between Methods of Reconstruction after Nasal BCC Skin Excision

Background: Basal cell carcinoma (BCC) is the most common malignant cutaneous lesion affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges after excision of BCC, and in addition to size and depth of the tumor, aesthetic considerations such as color, contour, skin consistency, nose retraction and scarring plays a major role in selecting the type of nasal tumor reconstruction surgery in order to obtain natural function and a beautiful appearing nose. Since a patient’s skin is thicker in this area and also because of the late referral of patients for treatment and also having to make a choice concerning an appropriate reconstruction method for preventing tumor recurrence in future, and achieving appropriate function of nose and appearance, it was decided to compare flap, graft and primary closure methods.

Methods: This retrospective study reviewed 80 patients suffering from basal cell cancer (BCC) who underwent tumor excision and nasal reconstruction during September 2014 to April 2018. In this study the amount of satisfaction, beaut y and recurrence of the illness after nasal reconstruction was evaluated in 4 weeks, 6 months and 19 months after surgery.

Results: In the present study, although using graft surgery is accompanied with maximum satisfaction in the short term due to it facilitating the work at hand and due to less use of skin excision in comparison with flap surgery, but in the long term it is accompanied with undesirable results due to the resulting unattractive appearance. In our study we surprisingly found that long term flap reconstruction often leads to optimal satisfaction and cosmetic results in comparison with graft and primary closure method after 6^th months that were found to be completely meaningful using chi-square test with a p-value of 0.05.

Conclusion: Since the results obtained in our study are meaningful according to the satisfaction level and by achieving aesthetic considerations of patients, the flap method is proposed as opposed to the two methods of graft and primary closure, obtaining tumor free margins and pleasing aesthetic results are major concerns in nasal reconstruction.; In small excised BCC tumors where the resulting defects are equal to or smaller than 1.4 cm, in order to prevent tumor recurrence in the future, instead of excising a margin of 2 mm or less, right from the start a margin of 4 mm or more is excised and flap surgery is performed instead of primary closure.

Author(s):

Ali Alizade*, Hosseini SN and Vakili MM

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