Korean J Dermatol.  2000 Feb;38(2):198-206.

Facial Reconstruction with Local Flap after Mohs Micrographic Surgery of Basal Cell Carcinoma

• Lee BG
• Lee MS
• Kim KH
• Joh GY
• Kim JT

Abstract

BACKGROUND: Up to eighty percent of all basal cell carcinomas occur in the head and neck region. Mohs micrographic surgery(MMS) was known as an ideal treatment for primary or secondary basal cell carcinoma. The surgical defects after the removal of malignant skin lesions are usually reconstructed with secondary intention, primary closure, skin graft, and local flap. When we reconstruct the surgical defect, we must consider the reconstruction method, defect site or size, recurrence, patient age, general health state, and functional and cosmetic aspects.
OBJECTIVE
The purpose of this study was to evaluate the cure rate and the reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the face after MMS.
METHODS
From March 1991 to February 1998, fifty-seven patients were diagnosed histologically with basal cell carcinoma on the face at the department of dermatology of our unit. All the tumors were removed with MMS. According to the facial cosmetic unit, we divided the face into nose, cheek, eyelid, forehead, and temple. We reviewed the local flaps after Mohs micrographic surgery of basal cell carcinoma.
RESULTS
1. 50 of the 57 patients(86%) who had been diagnosed as basal cell carcinoma visited our hospital after their tumors increased over 10mm. Only one case among the fifty seven cases having MMS showed recurrence which means cure rate is ninty eight percent. 2. The forty two patients(74%) who had basal cell carcinoma on the head and neck were treated with local flap, ten patients(17%) were treated with primary closure, and five patients(9%) were treated with skin graft to reconstruct skin defect after MMS. 3. Reconstruction of the nose after MMS of basal cell carcinoma : Of the twenty nine patients that had basal cell carcinoma on the nose twenty four were local flap. The large defects were repaired by glabella and nasolabial flap, while small defects were Banner flap, and Limberg flap. 4. Reconstruction of the the cheek after MMS of basal cell carcinoma : Of the twelve patients that had basal cell carcinoma on the cheek ten were local flap. We preferred to reconstruct the cheek with cheek rotation flap. 5. Reconstruction of the eyelid after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the eyelid five were local flap. The depth of invasion was limited to the anterior lamella. We reconstructed the eyelid with variable local flap like unipedicle flap, bipedicle Tripier flap, cheek advancement flap, and glabella flap. 6. Reconstruction of the forehead, temple, scalp, and auricle after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the temple, scalp, and auricle three were local flap. We reconstructed the defects with scalp rotation flap, glabella rotation flap, and Banner flap.
CONCLUSION
MMS is an ideal method for the treatment of basal cell carcinomas in that it provides 98% cure rates and maximum preservation of normal tissue by complete surgical margin control. Because of high cure rates(98%) after MMS, we can reconstruct the head and neck, especially face with the local flap which obtained the desired result functionally and aesthetically compared with other reconstruction methods like skin graft and secondary intention.

Keyword

Basal cell carcinoma; Mohs micrographic surgery; Local flap

MeSH Terms

Carcinoma, Basal Cell*
Cheek
Dermatology
Eyelids
Forehead
Head
Humans
Intention
Mohs Surgery*
Neck
Nose
Recurrence
Scalp
Skin
Transplants