Cutaneous nasal malignancies: is primary reconstruction safe?

Skin cancer continues to be the most common tumor in the United States, affecting 1 out of every 7 Americans. Of the numerous sites of presentation, the most common is the head and neck, and particularly the nose. Because of the propensity towards cutaneous recurrence in this region, care must be taken regarding the timing of nasal reconstruction. This manuscript reexamines the safety of primary nasal reconstruction through a retrospective review of 71 patients resected for basal cell carcinoma (n = 49), squamous cell carcinoma (n = 10), melanoma (n = 7), and 5 additional variable malignancies. The nasal dorsum was the most frequently affected site, and the forehead flap was the most common reconstructive modality employed. Of the 26 patients with recurrent lesions, 3 recurred after nasal reconstruction. We conclude that primary reconstruction is safe in selected patients; however, surgical delay should be considered if margins are questionable, if pathology if aggressive, if perineural or deep bony invasion is present, or if post-operative radiotherapy is required.