Cutaneous nasal malignancies: Is primary reconstruction safe?

Abstract

Background The nose is particularly vulnerable to cutaneous malignancies, making it the most common location for presentation. Recurrence of these cutaneous lesions is not uncommon, often compromising the timing of nasal restoration. It is the purpose of this report to reexamine the safety of primary nasal reconstruction in selected patients. Methods Seventy‐one patients who underwent nasal reconstruction at The University of Texas M. D. Anderson Cancer Center between 1987 and 1995 were retrospectively reviewed. There were 35 men and 36 women with an average age of 60 years. All nasal reconstructions were performed for defects secondary to malignancies. Basal cell carcinoma was the most common lesion (n = 49), followed by squamous cell carcinoma (n = 10) and melanoma (n = 7), with five additional variable malignancies. The most common location of the cutaneous lesions was the nasal dorsum, and the forehead flap was the most common adjacent tissue used for reconstruction. Immediate reconstruction was performed for 42 of the basal cell carcinomas, 6 of the squamous cell carcinomas, 6 melanomas, and 3 other lesions. Delayed restoration was performed for 7 basal cell carcinomas, 4 squamous cell carcinomas, 1 melanoma, and 2 additional lesions. The average time between surgical extirpation and the start of nasal reconstruction was 8.2 months for basal cell carcinoma, 29 months for squamous cell carcinoma, and 10 months for melanoma. Results Twenty‐six recurrent lesions were identified at an average of 36 months after extirpation. Despite these numbers, only three recurred after nasal reconstruction at our institution. Follow‐up averaged 41 months, with none less than 1 year. Seventy patients are still alive with no evidence of disease. Conclusion Primary reconstruction is safe in selected patients. Surgical delay in reconstruction should be considered if margins are questionable, the pathology is determined to be aggressive, if there is perineural or deep bony invasion, or if postoperative radiotherapy is to be initiated. Nasal reconstruction ultimately is based upon a complex series of issues but can be performed with few complications in an effort to restore self‐image. © 1997 John Wiley & Sons, Inc. Head Neck 19: 182–187, 1997.

An approach to managing non-melanoma skin cancer of the nose with mucosal invasion: our experience

“…The mid-facial location and the prominent morphology account for its constant exposure to ultraviolet radiation, the main aetiological factor for skin cancer genesis [22]. Approximately 25% of head and neck skin cancers develop in the nasal pyramid [1]. The main locations are the nasal ala (45%), dorsum (17%) and tip (5.5%) [2].…”

“…Frozen section histological examination was performed to confirm complete tumour extirpation. Immediate reconstruction was not performed [1]. After surgery, adjuvant radiotherapy was not performed in any case.…”

“…After surgery, adjuvant radiotherapy was not performed in any case. An 8 month follow-up for BCCs was observed and 15 months for SCCs [1,4], with an outpatient visit every 2Á3 months conducted by one of the physicians involved in the study.…”

“…The nasal pyramid is the most common site for the presentation of head and neck cutaneous malignancies, particularly in sun-exposed areas sucha as the ala, dorsum and tip of the nose [1,2]. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are mainly observed.…”

“…Malignant melanomas and other neoplasms occur more rarely [1Á4]. In comparison to other skin sites, the nose is the most frequent site of recurrence following ablation of skin cancers [1,5]. According to tumour characters several therapeutic approaches have been proposed: electrodessication and curettage, cryosurgery, radiotherapy, traditional surgery and Mohs' surgery [2].…”