Mohs Surgery Case - Micronodular Basal Cell On The Nose

A 72 year-old male patient, presented to our office for the evaluation of a non-healing lesion on his nose.  The patient stated that the lesion had been present for approximately 8 months.  He thought that it was just a pimple that would not go away.  If there is a lesion on the skin that does not go away within a few days, it is important to always get it looked at. That is what this patient did. A biopsy of the lesion demonstrated a micronodular basal cell carcinoma.  Mohs surgery was performed.  After 2 stages of surgery the final defect can be seen below (Figure 1).

Figure 1.


Closure options for this defect included a full thickness skin graft, and local tissue flaps.  Of greatest importance was ensuring that the right nostril was not distorted and that the air passage on either side was not compromised.  The patient stated that he did not want a graft.  Together with the patient, we agreed on a superiorly based bi-lobed transposition flap.  The final closure can be seen below (Figure 2).

Figure 2.


Sutures were removed after one week, and many had already dissolved on their own (Figure 3).  The nose was level and centered and excellent early surgical results were noted.  No anatomic distortion was appreciated, and the patient could breathe normally out of each nostril.  He was very happy with the results.

Figure 3.


Basal cell carcinomas are the most common skin cancers dignosed each year. These are slow growing tumors, but they are more than just skin deep. They can eat through muscle, cartlidge, and bone, and can become extremely disfiguring if left untreated. If there is a lesion that you are unsure about, always have it checked out. You would rather be overly cautious. If you have a skin lesion that you would like biopsied, please come visit a provider at Pine Belt Dermatology & Skin Cancer Center.

Dr. David Roy Lead Pine Belt Dermatology Physician

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