Repair of Defects of the Nasal Tip After Mohs Surgery

Repair of Defects of the Nasal Tip After Mohs Surgery

Authors

  • Sasia Pedersen Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital
  • John Paoli Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Robert Gniadecki Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital
  • Martin Glud Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital

Keywords:

Mohs micrograohic surgery, sasal cell carcinoma, squamous cell carcinoma, nasal tip, flap surgery

Abstract

Introduction: Mohs Micrographic Surgery (MMS) is a treatment option for high-risk facial nonmelanoma skin cancer with high cure rates. Especially on the nasal tip, the tissue sparing properties of MMS are appealing. The nasal tip is a common location of nonmelanoma skin cancer and can be a challenging anatomical structure for reconstructive surgery due to its prominent location in the face, the shortage of spare tissue, as well as the stiffness and composition of different skin types, cartilage and bone.

Objectives: The aim of the present paper is to review and demonstrate how reconstruction of the nasal tip can be done successfully to improve the care for patients undergoing MMS in this area.

Methods: Using selected literature on the area and the surgeons experience, each method of repair are described including their individual advantages and challenges. Pictures and consent were selected from one patient who underwent each repair method and three photos are presented in this paper: one after tumor resection, one immediately after repair, and one minimum 6 months post-surgery.

Results: We present eight surgical methods as well as pictures from previous surgeries.

Conclusions: The results demonstrate obtainable results using very different surgical methods and the importance of an individualized approach to repairing cutaneous defects of the nasal tip.

References

Ad Hoc Task Force, Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol. 2012;67(4):531–550. DOI: 10.1016/j.jaad.2012.06.009. PMID: 22959232.

Work Group; Invited Reviewers; Kim JYS, Kozlow JH, Mittal B, Moyer J, Olenecki T, Rodgers P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-578. DOI: 10.1016/j.jaad.2017.10.007. PMID: 29331386. PMCID: PMC6652228.

Work Group; Invited Reviewers; Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018r;78(3):540-559. DOI: 10.1016/j.jaad.2017.10.006. PMID: 29331385.

Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer. 2020;128:83-102. DOI: 10.1016/j.ejca.2020.01.008. PMID: 32113942.

Peris K, Fargnoli MC, Garbe C, et al. Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. Eur J Cancer. 2019;118:10-34. DOI: 10.1016/j.ejca.2019.06.003. PMID: 31288208.

Tolkachjov SN, Brodland DG, Coldiron BM, et al. Understanding Mohs Micrographic Surgery. Mayo Clin Proc. 2017;92(8):1261-1271. DOI: 10.1016/j.mayocp.2017.04.009. PMID: 28778259.

Benedetto PX, Poblete-Lopez C. Mohs Micrographic Surgery Technique. Dermatol Clin. 2011;29(2):141-151, vii. DOI: 10.1016/j.det.2011.02.002. PMID: 21421140.

Cameron MC, Lee E, Hibler BP, et al. Basal cell carcinoma. J Am Acad Dermatol. 2019;80(2):321-339. DOI: 10.1016/j.jaad.2018.02.083. PMID: 29782901.

Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years. J Am Acad Dermatol. 2005;53(3):445-451. DOI: 10.1016/j.jaad.2005.04.083. PMID: 16112351.

Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the US Population, 2012. JAMA Dermatol. 2015;151(10):1081-1086. DOI 10.1001/jamadermatol.2015.1187. PMID: 25928283.

Mansouri B, Bicknell LM, Hill D, Walker GD, Fiala K, Housewright C. Mohs Micrographic Surgery for the Management of Cutaneous Malignancies. Facial Plast Surg Clin North Am. 2017;25(3):291-301. DOI: 10.1016/j.fsc.2017.03.002. PMID: 28676157.

van Loo E, Mosterd K, Krekels GAM, Roozeboom MH, Ostertag JU, Dirksen CD, et al. Surgical excision versus Mohs’ micrographic surgery for basal cell carcinoma of the face: A randomised clinical trial with 10 year follow-up. Eur J Cancer. 2014;50(17):3011–3020. DOI: 10.1016/j.ejca.2014.08.018. PMID: 25262378.

Gniadecki R, Glud M, Mortensen K, Bang B, Biskup E, Omland SH. Favourable results of Mohs micrographic surgery for basal cell carcinoma. Dan Med J. 2015;62(12):A5171. PMID: 26621396.

Kim DP, Kus KJB, Ruiz E. Basal Cell Carcinoma Review. Hematol Oncol Clin North Am. 2019;33(1):13-24. DOI: 10.1016/j.hoc.2018.09.004. PMID: 30497670.

Richmond-Sinclair NM, Pandeya N, Ware RS, et al. Incidence of basal cell carcinoma multiplicity and detailed anatomic distribution: longitudinal study of an Australian population. J Invest Dermatol. 2009;129(2):323–328. DOI: 10.1038/jid.2008.234. PMID: 18668137.

Joseph AW, Joseph SS. Mohs Reconstruction and Scar Revision. Otolaryngologic Clinics of North America [Internet]. 2019 Mar [cited 2019 Apr 2]; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0030666519300027PLEASE PROVIDE DATE OF ACCESS

Paver R, Stanford D, Storey L. Dermatologic surgery: a manual of defect repair options. 2017. PLEASE PROVIDE PAGES

Goldberg LH, Alam M. Horizontal advancement flap for symmetric reconstruction of small to medium-sized cutaneous defects of the lateral nasal supratip. Journal of the American J Am Acad Dermatol. 2003;49(4):685-689. DOI: 10.1067/s0190-9622(03)01833-4. PMID: 14512917.

Geist DE, Maloney ME. The "east-west" advancement flap for nasal defects: reexamined and extended. Dermatol Surg. 2012;38(9):1529-1534. DOI: 10.1111/j.1524-4725.2012.02453.x. PMID: 22672609.

Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. 1989;125(7):957–959. PMID: 2742390.

Peng VT, Sturm RL, Marsh TW. “Pinch Modification” of the Linear Advancement Flap. J Dermatol Surg Oncol. 1987;13(3):251-253. DOI: 10.1111/j.1524-4725.1987.tb03946.x. PMID: 3546432.

Ahern RW, Lawrence N. The Peng flap: reviewed and refined. Dermatol Surg. 2008;34(2):232–237. DOI: 10.1111/j.1524-4725.2007.34043.x. PMID: 18093195.

Shan R Baker. Local Flaps in Facial Reconstruction. Second Edition. Mosby. 2007: 71-105.

WM Weathers, EM Wolfswinkel, H Nguyen et al. Expanded Uses for the Nasolabial Flap. Semin Plast Surg. 2013;27(2):104–109. DOI: 10.1055/s-0033-1351234. PMID: 24872750. PMCID: PMC3743915.

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Published

2023-10-31

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Section

Review

How to Cite

1.
Repair of Defects of the Nasal Tip After Mohs Surgery. Dermatol Pract Concept [Internet]. 2023 Oct. 31 [cited 2024 Jul. 13];13(4):e2023228. Available from: https://dpcj.org/index.php/dpc/article/view/3228

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