Case of the Month March 2020

A 78-year-old female patient presented to our office for evaluation of a non-healing lesion located on the left side of her nose (Figure 1).  Biopsy of the lesion demonstrated an infiltrative basal cell carcinoma.  We discussed treatment options with the patient and her family, and it was decided that the lesion would be treated with Mohs surgery.

 

Figure 1.

Three-four stages of Mohs micrographic surgery were required to clear the tumor.  The final defect involved a significant portion of the patient’s left nose (Figure 2).  Luckily, the bone was not involved. 

Figure 2.

Several closure options were reviewed with the patient.  Grafting was discussed, but she and her husband had significant concerns regarding the look of a graft.  Ultimately, the patient opted for a variation of a Mustarde Flap.  This flap had the advantage of being performed in a single stage while yielding a cosmetically pleasing result.  Tissue from the lower eyelid, malar cheek and lateral aspect of the cheek were elevated and moved (advanced and rotated) centrally (Figure 3).  This allowed for complete closure of the wound while keeping the patient’s anatomy correct.

Figure 3.

The sutures were removed after one week of healing (Figure 4).  The patient was extremely happy with the results and had no complications during the course of her healing. 

Figure 4.

At 3 months, excellent surgical results were noted (Figures 5 and 6).

Figure 5.

Figure 6.

Author
Dr. David Roy Lead Pine Belt Dermatology Physician

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