Undermining plastic surgery as a possible option for treating basal cell carcinoma of the forehead

Abstract

Basal cell carcinoma (BCC) is the most common cutaneous cancer. Although most cases can be cured with simple surgical procedures and are associated with a good prognosis, a minority of BCCs may pose significant therapeutic challenges. This occurs mostly in cases of so-called advanced BCC, which a loosely defined term that encompasses locally advanced lesions and tumors with metastatic spread. Treatment of these cases is often complex and sometimes may need combinations of therapeutic modalities, including surgery, radiotherapy and/or targeted therapy directed towards sonic hedgehog (SHH) signaling pathways, such as vismodegib. We herein present the case of a 74-year-old man presenting with a large basal cell of the forehead evolving for more than 7 years. The patient underwent excision of the lesion with clear surgical margins. Reconstruction of the defect was performed after extensive undermining of the skin allowing subsequent direct closure with a simple suture, which resulted in an acceptable cosmetic outcome. We discuss the potential advantages, disadvantages, and applicability of this relatively simple surgical maneuver in the reconstruction of defects resulting from excision of considerably large cutaneous tumors.

Basal Cell Carcinoma Surgery: Simple Undermining Approach in Two Patients with Different Tumour Locations

“…In conclusion, undermining or extendable plastic surgery is a simple surgical approach with proven benefits concerning closing-tension of skin defects, especially in the scalp region. Published data confirm the fact that undermining can decrease tension at the wound margins, allowing good intraoperative control of these margins with diminished trauma when compared to more elaborate plastic surgical procedures and with potentially better results [ 14 , 21 ].…”

“…Tumour size and location, the patient’s general condition, and the physician’s experience with particular therapeutic modalities are key considerations. Undermining plastic surgery has proven to be a good alternative to complex grafts or flaps for the treatment of selected cases of locally advanced BCCs, with the advantage of being less traumatic, allowing for good intraoperative control of clinical margins and good esthetic results [ 14 ]. Basal cell carcinoma is the most frequent cutaneous neoplasm worldwide.…”

Comparative Analysis of the Applicability of Island Flap in Primary and Recurrent Basal Cell Carcinomas of Similar Localization

“…Basal cell carcinoma is the most common malignant tumour composed of cells resembling those of the basal layer of the epidermis [ 1 ]. The disease rate is 200/100.000 people on the average [ 2 ] [ 3 ]. The affection of patients with white skin, fair hair and blue eyes, as well as male patients, prevails [ 4 ] [ 5 ].…”