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Simultaneous Surgery for Multiple Facial Basal Cell Carcinoma Excision: Modified Hughes Procedure and Rieger Nasal
Emirhan Ozkul1,2, Ahmed H Cokkeser3, Mehmet S Mangan2
1Department of Ophthalmology, Sancaktepe Prof. Dr. Ilhan Varank Education and Research Hospital, University of Health Sciences.
The Journal of Craniofacial Surgery
|October 16, 2025
Summary
This case study reports synchronous basal cell carcinoma (BCC) on the lower eyelid and nasal alar rim. Simultaneous surgical reconstruction using Hughes and Rieger flaps achieved successful outcomes with clear margins.
Area of Science:
- Ophthalmology
- Otorhinolaryngology
- Dermatologic Surgery
Background:
- Basal cell carcinoma (BCC) can present in the periocular region.
- Synchronous BCCs on the lower eyelid and nasal alar rim are rare.
Purpose of the Study:
- To report a unique case of simultaneous lower eyelid and nasal alar BCC.
- To highlight the efficacy of concurrent multidisciplinary surgical reconstruction.
Main Methods:
- A patient with biopsy-proven BCC on the left lower eyelid and nasal alar rim underwent simultaneous resection and reconstruction.
- Lower eyelid reconstruction utilized a Hughes flap, and nasal alar rim reconstruction used a Rieger flap.
- Frozen section and histopathology confirmed tumor-free margins.
Main Results:
- Histopathology confirmed nodular and adenoid BCC in both specimens.
- All surgical margins were clear.
- The patient experienced an uneventful postoperative course with no recurrence during follow-up.
Conclusions:
- Ophthalmologists should examine the entire face for potential BCC, not just the periocular area.
- Simultaneous multidisciplinary surgery can optimize patient care and reduce costs.
- This is the first reported case of synchronous lower eyelid and nasal alar BCCs managed with concurrent Hughes and Rieger flap reconstructions.
