Austin Skin Cancer and Mohs Reconstruction for the Face and Nose
The nose is a common sight for skin cancer on the face. Skin cancer of the nose is usually basal cell carcinoma. Squamous cell carcinoma occurs but is rarer, and melanoma is rarer yet. Skin cancer of the nose case be removed by a dermatologist, a mohs surgery trained dermatologist, or by a plastic surgeon. Excision of skin cancer leaves a defect that can involve the outer skin, the underling cartilage (and even bony) skeleton, and the nasal lining within the nostrils. These defects if left unrepaired can affect both the appearance and function of the nose.
Small nasal defects can be closed directly with sutures alone and generally do not require the assistance of a plastic surgeon. Larger nasal defects require more complex solutions and benefit from the skin an experience of a plastic surgeon. The algorithm that determines the most appropriate approach from nasal skin cancer reconstruction is a complex one. Suffice it to say; progressively larger defects require progressively more elaborate solutions.
Smaller defects can be reconstructed with skin grafts. Generally skin grafts are taken from the upper/outer forehead or from the bowl portion (concha) of the ear. The reason for the choice of these two locations over the other areas of the face or body as a donor site is that the color, texture, thickness, and pore size of the forehead and the conchal bowl skin is most similar to that of the nose.
Mid-sized defects are generally reconstructed using intra-nasal flaps. An intra-nasal flap refers to rearranging tissue (skin and the underlying fat) on the nose in order to gently and precisely position it into the defect left from skin cancer excision. These flaps care named for the either their shape or location and include the pennant flap, bi-lobed flap, and dorsal nasal flap. It should be noted that while these flaps are indicated for midsized defects they are not the method of choice for defects that are close to the nostrils
Larger defects and complex defects, usually implying those that involve nasal lining, require the forehead flap procedure. This is a three-staged surgical process of nasal reconstruction that takes place over a two month period. The first stage entails formation of the forehead flap, which is a segment of skin an fat taken from the central forehead, and pivoting down so that the end of it reaches and covers the nasal defect. The second stage occurs one month later and involves lifting the tissue back up so that it can be sculpted to the exact dimensions and shape required for a precise reconstruction. One month later again the third step takes place and involved disconnecting the tissue from the forehead so that it rests on the nose only.
- Dedicated to the field of nasal reconstruction
- Published innovator in the field of nasal reconstruction
- Invited lecturer and scientific discussant in the field of nasal reconstruction
Generally, these procedures are not significantly painful. One should plan to have someone help with driving and the activities of daily living for about one or two days after surgery. Some bruising and swelling is expected but generally is minor and resolves in about one week. Most procedures are performed on an outpatient basis with the exception of the first stage of the three-staged forehead flap procedure. In this case patients generally stay in the hospital for a 23 hours observation status one night.