Cancer of the nose: ablation and repair

Cancer of the nose is very common and lesions seen by reconstructive surgeons are often recurrent and extensive. Surgical removal of cancer of the nasal skin can usually be accomplished under local anesthesia, and in most instances frozen section histologic examination should be used to confirm the adequacy of excision. The location and three dimensional extent of the tumor will dictate the choices of repair or reconstruction as well as the timing thereof. Very small lesions can be excised with primary closure; other well circumscribed tumors can be excised and the defect closed with an appropriate nasal flap. In our experience most nasal skin cancers have been managed by excision and full-thickness skin grafting. We have found the skin of the neck and that of the preauricular region to provide the best skin cover except in the upper third of the nose where upper eyelid skin provides excellent coverage. We have used composite grafts from the ear to replace up to two-thirds of an alar rim. Nasolabial, cheek, and midline forehead flaps are useful in a variety of instances, but usually when less than one-half of the nose has been excised. We have been pleased, in most instances, with the Converse scalping flap for near total, subtotal, and extensive three-dimensional lower nasal defects. (Transverse superficial temporal artery pedicle flaps can be successfully used to reconstruct large nasal defects with adjacent cheek loss.) We have rarely used distant flaps. Regardless of what regional pedicle flap has been transferred to the nose, subsequent revisions of a relatively minor nature will nearly always enhance the result. Patients who have undergone extended total nasectomies are probably best managed with a prosthesis, as prognosis is often guarded and flap reconstruction may be quite unsatisfactory. In our experience, defects in lining and support can usually be repaired with local nasal tissue.