Basal Cell Carcinoma in Nasal Tip and Dorsum - Bilobed Flap Repair

Diagnosis: Basal Cell Carcinoma (BCC)

Basal cell carcinoma involving the nasal tip and dorsum, treated with bilobed flap reconstruction. Case submitted by Dr. Adevair Marques Filho.

Clinical Presentation

Patient presented with a lesion on the nasal tip and dorsum consistent with basal cell carcinoma. Clinical examination revealed a well-defined tumor requiring surgical excision.

Clinical History

Basal cell carcinoma of the nose. Surgical excision performed with bilobed flap reconstruction for wound closure.

Treatment

Surgical excision with bilobed flap reconstruction. The bilobed flap technique was selected for optimal cosmetic and functional outcome given the location on the nasal tip and dorsum.

Differential Diagnosis

• Squamous cell carcinoma • Amelanotic melanoma • Intradermal nevus • Sebaceous hyperplasia • Trichoepithelioma • Merkel cell carcinoma • Dermatofibroma

Key Learnings

• Most common human cancer — accounts for ~80% of non-melanoma skin cancers • Locally destructive but rarely metastasizes (<0.1%) • Classic dermoscopy: arborizing vessels, blue-gray ovoid nests, leaf-like structures, spoke-wheel structures • Subtypes: nodular (most common), superficial, morpheaform/infiltrative (highest recurrence), pigmented • Gorlin syndrome (PTCH1 mutation): multiple BCCs, odontogenic keratocysts, skeletal anomalies • Hedgehog pathway inhibitors (vismodegib, sonidegib) for advanced/inoperable BCC

Tags: basal cell carcinoma, BCC, Mohs surgery, bilobed flap, nasal reconstruction, skin cancer, dermatologic surgery