Reconstruction for basal cell carcinoma in an anatomical region where the sun does not shine: an attractive option!

Abstract

Basal cell carcinoma is one of the common skin malignancies but it is rarely found in sun-protected areas. The soft tissue reconstruction at the perianal region can be challenging and a variety of options are described in the literature. The keystone design perforator island flap is an excellent and attractive option for soft tissue reconstruction. We present a case of perianal basal cell carcinoma that was reconstructed with a unilateral keystone flap.Basal cell carcinoma (BCC) is one of the common skin malignancies but it is rarely found in sun-protected areas.1 The soft tissue reconstruction at the perianal region can be challenging and a variety of options are described in the literature.1-5 The keystone design perforator island flap is an excellent and attractive option for soft tissue reconstruction. 2 We present a case of perianal BCC that was reconstructed with a unilateral keystone flap. Case historyA 58-year-old man presented to colorectal surgeons with a 6-month history of a slowly growing, painless lesion with an occasional history of bleeding. The patient was in excellent health and had no prior history of skin cancer.On examination, a 6cm x 3cm ulcerated lesion with an ill defined margin was present at the natal cleft (Fig 1). There was no local or regional lymphadenopathy. Digital rectal examination and sigmoidoscopy were normal with no sphincter involvement. The punch biopsy confirmed BCC.The patient was referred to the regional plastic surgery department for reconstruction due to the location of the lesion. He underwent 4mm excision with a cuff of fat and unilateral keystone flap reconstruction. The patient had an unremarkable recovery post-operatively. The histology report showed a completely excised BCC with 4mm peripheral and 9mm deep margin clearance. The post-operative course was unremarkable. At the one-year follow-up appointment there was no evidence of recurrence and durable flap coverage had been achieved (Fig 2).