Unmasking nasal basal cell carcinoma: Strategies for defect coverage

Many reconstruction methods have been introduced for the reconstruction of basal cell carcinoma (BCC) post excision however no study has described the preferred reconstruction method in the Malaysia setting. Variations in resource availability and surgical training between regions may affect reconstructive choices. This study intends to find out our preferred method for reconstruction in nasal BCC patients post excision in our centre.

We conducted a retrospective chart review of patients undergoing different reconstruction methods and assessing outcomes for a series of patients with BCC post-resection, conducted in Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II, Kelantan, from 2012 to 2024.

A total of seven patients were identified in this retrospective study, comprising five females and two males. The ages of these seven patients range from 60 to 77 years old. All seven patients who underwent excision postoperatively underwent immediate soft tissue reconstruction with either a local or regional flap, a free flap, or a combination of flaps. Among those seven patients, only one developed flap-related complications. All patients were followed up for at least 3 months, with a range of 3-38 months. Functional and cosmetic assessments over the resected area post-reconstruction were good.

Local flaps remain the preferred option for small and medium nasal BCC defects, while forehead flaps and free flaps are reserved for larger or complex defects. In Asian patients, thicker skin and pigmentation influence flap design and thinning to optimize outcomes.