Abstract

Non-melanoma skin cancers are the most frequent skin tumours; in 25.5% of cases, they are reported to affect the nasal area. For an excellent surgical outcome, first of all the radical excision of the lesion is important, with appropriate margins of healthy skin in order to avoid recurrences. Moreover is important to achieve a good aesthetical result, avoiding distortion of the aesthetic units and preserving their functions. We have applied the modified crescentic flap, described by Smadja in 2007, to 24 nasal skin defects left by oncologic surgery. It consists of the crescent-shaped resection of Burow's triangle all around the alar groove that allows the advancement of the flap to the tip of the nose, hiding the scar in the alar groove. The outcome and the long-term follow-up were completely satisfactory both for patients and for surgeons. For skin defects localized in the midline or paramedian line of the dorsum of the nose, the crescentic flap seems to be a good solution to obtain the better aesthetic result with respect to both anatomy and function of the nasal area, sparing the patient a second intervention or an overly invasive procedure.

Highlights

  • Skin cancers are traditionally divided into two groups: melanoma and non-melanoma skin cancers (NMSCs)

  • The above-mentioned technique of crescentic flap has been applied to 24 cases of nose reconstruction after surgical excision of nodular basal cell carcinomas more than 1 cm in diameter arising on the dorsum of the nose, on the midline and paramedian line, near the tip (Figs. 1A and 2A)

  • The unilateral flap showed a small area of dehiscence in correspondence of the distal margin, and in the bilateral cases it appeared at the joint of the two flaps

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Summary

Introduction

Skin cancers are traditionally divided into two groups: melanoma and non-melanoma skin cancers (NMSCs). The latter are the most frequent skin tumours among the adult and elderly population; their incidence grows proportionally with age, and prolonged sun exposure is one of the highly proved risk factors for their onset. Basal cell carcinoma (BCC) is the most common tumour within the NMSC group, accounting for 77% of cases, followed by squamous cell carcinoma (SCC) at 20%. Major risk factors related to the onset of BCCs are UV cumulative exposure (in particular sun burns, and tanning treatments), advanced age, white skin, and, above all, Fitzpatrick's skin types I and II. SCCs are more frequent in individuals of white ethnicity with a history of exposure to UV rays and the human papillomavirus (HPV) infection (in particular types 16, 18, and 31) (Fleming et al, 1995; Salgarelli et al, 2010; Kallini et al, 2015)

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