4/8/2023 0 Comments Blue tinge on bridge of noseThe most common skin cancers of the nose in these patients were basal cell carcinomas (190 cases) and squamous cell carcinomas (96 cases). They comprised 167 males and 119 females, aged 42 to 92 years, who were followed for between 6 months and 7 years. Patients and MethodsĬonsecutive patients ( ) referred for excision of nonmelanoma skin cancers on the nose, from 2002 to 2009, were included. The results of a review of 286 patients with surgical defects of the nose following excision of skin malignancies are presented. Surgical defects in each subunit were usually repaired in a predictable and reproducible fashion. Here, we review our experience with nasal reconstructions. As the options for producing these results may be limited in some cases, familiarity with a variety of flaps is essential. Re-establishing the framework in nasal reconstruction is critical to achieving both form and function. Finally, the function of the nose must be maintained by preserving or replacing the bony and cartilaginous framework and the mucosal lining and by never compromising a patent airway. When planning the reconstruction of surgical defects, a surgeon must carefully consider a number of characteristics unique to the nose, including the inherent structural complexity of the nose, with convex and concave surfaces in close proximity, the symmetry of the nose, the limited laxity of the nasal skin, and the sebaceous composition of distal nasal skin. Given the vital functions of the nose in everyday life, it is extremely important that the reconstruction of facial defects preserves the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. ![]() After tumor-free margins on frozen section have been established, reconstruction of the surgical wound can be performed with confidence. In addition, high cost has been a criticism of Mohs surgery in the literature. The disadvantages of the Mohs technique are that it is labor intensive, time consuming, and quite dependent on the skills of not only the Mohs surgeon/pathologist but also the histotechnician who prepares the specimens. ![]() The Mohs technique described in 1941 is based on the concept of excising skin cancer layer by layer and examining horizontally cut specimen sections to view the entire surgical margin. For these tumors, Mohs micrographic surgery offers improved cure rates, as it is a technique that allows for complete microscopic control of tumor removal in addition to superior tissue preservation. Primary squamous cell carcinomas (SCCs) require 4.0-mm margins for low-risk tumors and 6.0 mm margins for high-risk tumors (≥2.0 cm >II histological grade nose, lip, scalp, ears, eyelids invasion into the subcutaneous tissue) to obtain a 95% cure rate. Well-defined primary basal cell carcinomas (BCCs) less than 2 cm in diameter should be excised with 4.0-mm margins to obtain a 95% cure rate. Several studies have outlined the surgical parameters necessary for the excision of primary nonmelanoma skin cancers. When dealing with primary non-melanoma nasal skin cancers, the most important goal is to obtain a tumor-free patient. The most common site of facial skin cancer is the nose (25.5%), because of its cumulative exposure to sunlight. All scars were inconspicuous and symmetrical. ![]() The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. ![]() Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome.
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