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A case report about achieving the greatest aesthetic result in curative surgery for a patient with basal cell carcinoma of the nose wing. Is only the size important?

Author(s): Jorge Eduardo Mendez Chavez

A case of an 83-year-old female patient with a 15 mm ulcerated lesion on the left nose wing of 5 months of evolution. The lesion was excised with macroscopically negative margins. A banner-shaped flap planned reconstruction was made, without any complications. The pathology report confirmed the histological lineage of basal cell carcinoma. With microscopically negative margins in depth and extension. After 1-year clinical follow-up, with good aesthetic results and absence of local recurrence has been achieved. About 85% of basal cell tumors settle on the face and neck. Despite its slow progression and exceptional metastatic capacity, without proper treatment, BCC is locally destructive, especially on the face and particularly the nose or nose wing. Treatment options with aesthetically satisfactory results may be limited when it comes to achieving negative margins in nasal wing surgery. There are proposed algorithms in the literature to take better decisions of reconstruction. These algorithms typically include categories based on the size of the primary lesion. The experience of this case proposes to take into account texture, thickness, amount of subcutaneous fat pad, elasticity of the surrounding skin, as well as long-term local complications that may occur, such as scar retraction or deformity. The employment of an algorithm allows surgeons to achieve more balanced outcome rates in curative reconstructive surgery for lesions of the nose, but, these algorithms must be completed with taking more local factors into account in the decision making process. Basal cell carcinomas (BCCs) typically occur in middle-aged to elderly patients but less commonly in younger ones. Basal cell carcinomas frequently extend beyond their visible borders. Therefore, the goal of surgical therapy must be to eradicate both the clinically apparent tumor and its microscopic extension into the surrounding normal-appearing skin. Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect.

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