Management of Nodular Nasal Basal Cell Carcinoma with Wide Excision, Transpositional Median Forehead Flap, Forehead Split Thickness Skin Graft: Case Report

Introduction: Basal cell carcinoma (BCC) is the most common skin type cancer with an incidence rate of around 75-80%. The most common location is in the head and neck area around 70-80% and followed by other body parts around 25% consist of the penis, vulva or perianal area and 5% on the skin. BCC occurs more frequently in light-skinned individuals compared to dark-skinned individuals. The incidence rate is relatively lower in Asians, blacks ethnic, and Hispanics.

Case Presentation: A 66 years-old woman complained of scabs on the right side of her nose which had become increasingly widespread for the past 2 years. The wound was initially the size of a mole and was scratched until it spread until the patient was hospitalized. Physical examination showed a wound in the nasal area measuring 4 x 5 x 1 cm, irregular wound edges, cartilaginous wound base with necrotic tissue and pus. The first biopsy examination showed poorly differentiated basal cell carcinoma. The patient was treated with Nasal Reconstruction surgery consisting of wide excision was performed by surgical oncologist, transpositional median forehead Flap and forehead Split Thickness Skin Graft were performed by reconstructive plastic surgeon.

Discussion: The diagnosis of BCC in this patient was based on regarding history taking, physical examination and histopathological examination. However, for defects with a diameter of more than 1.5 to 2 cm, generally recommended using axial pattern flaps such as forehead flaps, nasolabial flaps and dorsal nose flaps. In this case, the patient was treated with wide excision followed by nasal reconstruction with a transpositional forehead flap and forehead split thickness skin graft.

Conclusion: Nevertheless, regional flaps remain the recommended procedure for nasal reconstruction after wide excision of the tumor. Accurate analysis of the damage combined with evaluation of the patient's clinical condition is necessary to select the best surgical technique. Thorough knowledge of regional vascular anatomy and a comprehensive multidisciplinary approach are important first steps for proper treatment of nasal skin cancer, so that the procedure for wide excision of nasal basal cell carcinoma followed by nasal reconstruction with transpositional forehead flap and split thickness skin graft, can provide satisfactory result.