Surgical Strategy for Multiple Nasal Basal Cell Carcinomas: Narrow-Margin Excision With Secondary Intention Healing

Basal cell carcinoma (BCC) is the most common type of skin cancer, often occurring on the nose, where reconstruction is particularly challenging. Managing multiple nasal BCCs presents additional difficulties because multiple surgical defects within the same aesthetic subunit can limit flap mobility and compromise cosmetic outcomes. We report a case of two histopathologically confirmed nodular BCCs on the nasal dorsum treated with different surgical strategies tailored to each lesion. The left lesion, which required flap reconstruction, was excised with a 2-mm margin to ensure complete tumor removal. The right lesion, smaller and sharply demarcated, was excised with a 0.5-mm margin and allowed to heal by secondary intention. Histopathological examination confirmed tumor-free margins in both specimens. The open wound on the right side was completely epithelialized within three weeks, while the rotation flap on the left cheek healed uneventfully. At six months postoperatively, both sites demonstrated excellent cosmetic outcomes with minimal scarring and no recurrence. This case highlights that individualized surgical planning based on lesion characteristics and histopathologic subtype ensures both oncologic safety and aesthetic preservation. Narrow-margin excision with secondary intention healing represents a practical and minimally invasive option for small, well-defined nasal BCCs.