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?

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Jorge Eduardo Mendez Chavez

Jalisco, Mexico

: J Plast Surg Cosmetol

Abstract

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Summary: A case of an 83-year-old female patient is presented, with an ulcerated lesion of 5 months of evolution. The employment of complete clinical and aesthetic algorithm allows surgeons to achieve more balanced outcome rates in curative surgery of carcinomas of the nose. Abstract: 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.
References:
• Tran, H., Chen, K., & Shumack, S. (2003). Epidemiology and aetiology of basal cell carcinoma. The British journal of dermatology, 149 Suppl 66, 50–52. https:// doi.org/10.1046/j.0366-077x.2003.05622.x
• Gulleth, Y., Goldberg, N., Silverman, R. P., & Gastman, B. R. (2010). What is the best surgical margin for a Basal cell carcinoma: a meta-analysis of the literature. Plastic and reconstructive surgery, 126(4), 1222–1231. https://doi.org/10.1097/PRS.0b013e3181ea450d

Biography

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Jorge Eduardo Mendez Chavez is 30 years old. He has just completed his carreer as a general surgeon in 2021, from Guadalajara University and Hospital Civil of Guadalajara. By now he’s involved in general and surgery private pratice. a premier Bio-Soft service organization. He has published very interesting papers and oral presentations about abdominal wall reconstruction. And he is currently competing for a reconstructive surgery candidate.