phenylephrine-hydrochloride and Skin-Neoplasms

Numerous reconstructive techniques for nasal defects following skin cancer removal have been described; however, the literature lacks a comprehensive systematic review. Our objective was to systematically review nasal reconstruction methods after tumor removal, correlate the use of specific techniques to the nasal subunits involved, assess the quality of the available evidence, and set the stage for future research on this topic. Eight databases were searched for studies published in English from January 2004 to December 2018 containing repair data for nasal defects following Mohs or excision for four or more subjects. Recorded data included author specialties, study design, subject number, demographics, defect characteristics, procedure type, reconstructive methods, outcome measures, and complications. One-hundred and eleven studies were included. Study types included case series (73%), observational cohort studies (25%), and clinical trials (2%). Most authors were dermatologic surgeons (61%). Resection was most commonly performed via Mohs (82%). Flaps (42%), linear closures (28%) and grafts (25%) were most utilized for reconstruction. In Zones I and II, transposition flaps were the most common followed by advancement flaps. In Zone III, full thickness skin grafts were the most common repair. Most studies were case series or small cohort studies, representing low level evidence. Flaps are the most common method described in the literature for nasal reconstruction. The overall quality of the evidence available on this topic is low.

Topics: Humans; Mohs Surgery; Nose; Retrospective Studies; Skin Neoplasms; Surgical Flaps

Plasmoacanthoma (PA) is a verrucous tumor predominantly developing on periorificial areas, which has been considered as an unusual subtype of plasmacytosis circumorificialis. Because of its rarity and clinical resemblance to several verrucous dermatological disorders, accurate diagnosis of PA is quite challenging. Herein, we present an extremely unusual case of PA which arose on both sides of the nasal canthus and was successfully treated with intralesional corticosteroid injections. To elucidate clinicopathological features of this condition, a literature review was also attempted. A 78-year-old woman visited us with a 2-year history of eruptions affecting both sides of the nasal canthus. At a local clinic, the diagnosis and treatment had been unsuccessful due to non-specific histological findings, leading to the referral to our institute. On physical examination, verrucous and lobulated reddish plaques were observed. In histology, psoriasiform epidermal change and dense plasma cell infiltration in the dermis were detected. The diagnosis of PA was made. After 5-monthly intralesional triamcinolone acetonide injections, the lesions became hardly noticeable with no evidence of recurrence. A literature review found five PA cases. PA predominantly arose on the periorificial area, mostly in or around the mouth, except one case which developed on the extra-oral or perioral area. Intralesional corticosteroid injection has been preferably performed, which frequently achieved successful remission. Chronic inflammation has been reported as a preceding condition. Abundance of plasma cells in the lacrimal glands and conjunctiva, together with pre-existing allergic conjunctivitis and habitual scratching, might have contributed to PA development in our case. Histopathological detection of psoriasiform epidermal change and dense dermal plasma cell infiltration is indispensable for the diagnosis of PA. For accurate diagnosis, optimization of treatment, and further accumulation of extra-oral/perioral PA cases, a skin biopsy needs to be proactively performed on verrucous lesions on relatively unfamiliar orifice sites.

Topics: Adrenal Cortex Hormones; Aged; Female; Humans; Injections, Intralesional; Neoplasm Recurrence, Local; Nose; Skin Neoplasms

A quarter of cutaneous melanomas occur on the head and neck. Despite close collaboration between the dermatology, oncology, pathology, nuclear medicine and otorhinolaryngology departments, the survival of patients presenting with this type of melanomas remains inferior to that of other parts of the body. The morbidity of head and neck surgery significantly alters the quality of life. Therefore, specific multidisciplinary expertise is required. We present here the specificities of ENT management.. Un quart des mélanomes cutanés se présentent au niveau de la tête et du cou. Malgré une étroite collaboration entre les services de dermatologie, oncologie, pathologie, médecine nucléaire et oto-rhino-laryngologie (ORL), la survie des patients qui présentent ce type de mélanomes reste inférieure à celle des patients ayant un mélanome d’une autre partie du corps. La morbidité d’une chirurgie cervico-faciale modifie significativement la qualité de vie. Ainsi, une expertise spécifique multidisciplinaire est nécessaire. Nous présentons ici les spécificités de la prise en charge ORL des mélanomes cervico-faciaux.

Topics: Ear; Head and Neck Neoplasms; Humans; Melanoma; Nose; Pharynx; Physician's Role; Quality of Life; Skin Neoplasms

Rhinophyma is a benign disease involving the skin of the nose, which is characterized by skin thickening and hypertrophy of the sebaceous glands and connective tissue. It occurs predominantly by Caucasians in their fifth to seventh life decades and is 12-30 times more likely to affect males. The etiology and pathogenesis of Rhinophyma remains unclear, however it is generally stated to be the final stage of rosacea. A causative relationship between rhinophyma and alcohol consumption has not yet been proven. This review highlights the treatment options of rhinophyma. Surgery is gold standard for management of advanced rhinophyma. Each technique has pros and cons, but using surgical instruments with monopolar energy as loop and ball electrode seem to combine several goals best - first of all simultaneous removal and hemostasis followed by nasal contour refinement. Due to possible coincidence of skin cancer such as a basal- or squamous cell carcinoma, histopathological examination of all removed tissue is recommended.. Als Rhinophym wird eine benigne Hautveränderung der äußeren Nase bezeichnet, die durch eine Hypertrophie der Talgdrüsen gekennzeichnet ist. Betroffen sind meistens männliche Kaukasier zwischen der 5. und 7. Lebensdekade. Die Ätiologie der Erkrankung ist bisher nicht vollständig geklärt, sie wird jedoch als Spätstadium der Acne rosacea betrachtet. Ein äthyltoxischer Zusammenhang, wie bisher vermutet wurde, ist bis dato nicht belegt worden. Der Artikel gibt einen Überblick über mögliche operative und konservative Therapieansätze. Die chirurgische Therapie stellt dabei den Goldstandard dar. Dabei erweist sich der Einsatz der Elektroschlinge zur subtilen Resektion und die Verwendung der monopolaren Kugel zur Feinmodulation als besonders vorteilhaft. Aufgrund einer möglichen Koinzidenz des Basalzell- oder Plattenepithelkarzinoms im Rhinophymgewebe, erscheint eine histopathologische Aufarbeitung des abgetragenen Gewebes sinnvoll.

Topics: Humans; Hypertrophy; Male; Nose; Rhinophyma; Rosacea; Skin Neoplasms

The nose represents the most common site for the presentation of cutaneous cancer, especially in sun-exposed areas: ala, dorsum, and tip. Even the smallest loss of substance can create aesthetic and psychosocial concerns for patients; therefore, surgeons who perform nasal reconstruction should be strictly confident with the pertinent surgical anatomy in order to tailor the procedure to the patient's condition and needs. Radical tumor excision and satisfactory aesthetic and functional results are primary targets. Restoring the original shape is the goal of any reconstruction: appropriate reshaping of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures are paramount features. Multiple options exist to re-establish functional and aesthetic integrity after surgical oncology; nevertheless, the management of nasal defects can be often challenging, and the gold standard is yet to be found. The current goal is to highlight some of the more common techniques used to reconstruct cutaneous defects of the nose with a specific focus on decision making based on the aesthetic subunit and defect size. The authors attempt to share common pitfalls and offer practical suggestions that they have found helpful in their clinical experience.

Topics: Carcinoma, Basal Cell; Esthetics; Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon.. To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites.. A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms.. These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.

Topics: Ear Neoplasms; Ear, External; Eyelid Neoplasms; Eyelids; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Genitalia, Female; Genitalia, Male; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus).. The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus.. The authors performed a randomized controlled trial of S. aureus nasal swab-negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention.. In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29).. Topical decolonization reduces SSI in nasal swab-negative Mohs surgery patients.

Topics: Administration, Intranasal; Administration, Topical; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Carrier State; Chlorhexidine; Decontamination; Female; Humans; Male; Middle Aged; Mohs Surgery; Mupirocin; Nose; Preoperative Care; Skin Neoplasms; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Topics: Adult; Aged; Aged, 80 and over; Ear Auricle; Esthetics; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Treatment Outcome

Case 1 was a 75-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with a destructive defect in the center, measuring 3 cm × 2 cm on the right wing of his nose. The histological diagnosis was a common form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the wall of a follicular infundibulum. The majority of neoplastic cells were positive for AE1/AE3 and 34βE12. Cytokeratin 17 expression was seen in the suprabasal cells of the deeply situated neoplastic components. Case 2 was a 73-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with an irregularly shaped ulcer in the center, measuring 3 cm × 2 cm on the left wing of his nose. The histological diagnosis was a crater form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the broad base of the central keratin-filled crater, continuous with two infundibular canals. In both cases, some of the more deeply situated aggregations were composed of neoplastic keratinocytes with eosinophilic glassy or pale cytoplasm. In addition, no atypical keratinocytes could be seen in the interfollicular epidermis. In case 1, a hematogenous metastasis to the vocal cord and the forehead occurred in addition to a lymph node metastasis. In case 2, a local recurrence occurred with an intralymphatic dissemination. We describe two cases of infundibular squamous cell carcinoma on the nose with aggressive clinical behavior, one of which was accompanied by a hematogenous metastasis while another revealed a local recurrence.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Granuloma, Pyogenic; Humans; Laryngeal Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Neoplasm Recurrence, Local; Nose; Plaque, Atherosclerotic; Skin Neoplasms; Vocal Cords

Decisions about medical and surgical treatment can be complex-even for health care providers, who can struggle with which treatment option to offer their patients. In the current landscape of patient-centric value-based health care, the need for appropriate medical decision making to maximize treatment outcomes is evermore important. Shared decision making is a process in which clinicians and patients make decisions together using the best available evidence while accounting for the patients' values and beliefs. A patient-centered approach has been associated with improved patient satisfaction, clinical outcomes, and patient adherence to treatment. Only by taking a collaborative care approach among patients, physicians, and caregivers can we hope to deliver the best possible care and improve our outcomes for each and every patient.

Topics: Age Factors; Aged, 80 and over; Carcinoma, Squamous Cell; Clinical Decision-Making; Decision Making; Follow-Up Studies; Humans; Male; Mohs Surgery; Nose; Patient-Centered Care; Risk Assessment; Skin Neoplasms; Surgery, Plastic; Treatment Outcome

A 90-year-old Japanese woman presented with a dome-shaped, dark-red, ulcerated nodule measuring 23 mm × 19 mm × 9 mm on the right side of the nasal root. Histologically, anastomosing cord-like arrays of atypical polygonal keratinocytes exhibiting internal pseudolumina containing detached cells and erythrocytes were observed. Although acantholytic and cohesive areas overlapped, cancer pearls were not detected. The lower epidermis partially demonstrated scattered dyskeratotic and acantholytic keratinocytes with loss of polarity, continuous with an underlying tumor mass. The tumor cells were positive for a variety of cytokeratins, p40 and vimentin. The Ki-67 proliferation index was 50-60%. Both CD31 and CD34 were expressed in reactive blood vessels of the tumor. A local excision margined by 1 mm was performed, followed by X rays and electron beam irradiation. Neither lymph node nor distant metastasis has appeared over the 14 months since the excision. We performed a review of the published work and identified 24 previously reported patients with pseudovascular squamous cell carcinoma of the skin, oral mucosa and vulva to reassess the prognosis of this tumor. In 12 of these patients (50%), sites other than the head and neck were involved. Eight (33%) tumor-associated deaths occurred. It is believed that pseudovascular squamous cell carcinoma has a tendency to develop at morbid skin and mucous membranes sites in organs other than the face and neck and to possess an aggressive clinical behavior.

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Epidermis; Female; Humans; Nose; Prognosis; Skin Neoplasms

Nonmelanotic skin cancers (NMSCs) are the most frequent of all neoplasms and nasal pyramid represents the most common site for the presentation of such cutaneous malignancies, particularly in sun-exposed areas: ala, dorsum, and tip. Multiple options exist to restore functional and aesthetic integrity after skin loss for oncological reasons; nevertheless, the management of nasal defects can be often challenging and the best "reconstruction" is still to be found. In this study, we retrospectively reviewed a total of 310 patients who presented to our Department of Plastic and Reconstructive Surgery for postoncological nasal reconstruction between January 2011 and January 2016. Nasal region was classified into 3 groups according to the anatomical zones affected by the lesion: proximal, middle, and distal third. We included an additional fourth group for complex defects involving more than one subunit. Reconstruction with loco regional flaps was performed in all cases. Radical tumor control and a satisfactory aesthetic and functional result are the primary goals for the reconstructive surgeon. Despite tremendous technical enhancements in nasal reconstruction techniques, optimal results are usually obtained when "like is used to repair like." Accurate evaluation of the patients clinical condition and local defect should be always considered in order to select the best surgical option.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Esthetics; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Fibrous papules present clinically as benign, asymptomatic, dome-shaped, flesh colored papules on the face. Histologically, fibrous papules are characterized by fibrous stroma with fibroblasts and dilated blood vessels. Multiple variants of fibrous papules have been reported. Although scattered multinucleated cells in fibrous papules have been well described, we report a fibrous papule with abundant multinucleated ganglion-like giant cells that were immunoreactive with CD34. Recognition of such fibrous papule variants is important to avoid misdiagnosis as potentially more worrisome and/or aggressive melanocytic, soft tissue, or neural lesions that may require more aggressive treatment. Indeed, fibrous papules do not commonly appear on the differential diagnosis for lesions with multinucleated giant cells or ganglion-like cells and consideration should be given to their inclusion in the appropriate clinical setting.

Topics: Adult; Angiofibroma; CD4 Antigens; Cell Transformation, Neoplastic; Diagnosis, Differential; Giant Cells; Humans; Male; Melanoma; Nose; Risk Factors; Skin Neoplasms

Reconstruction of defects of the lateral nasal ala might be challenging. Reconstruction with a bi- or trilobed flap is common. The laterally based bi- or trilobed flap for defects of the distal ala or lateral tip of the nose produces mostly tissue protrusion in the nasal groove which is aesthetically unpleasant. Why not use more the medially based bi- or trilobed flap?. To describe the utility of bilobed and trilobed flaps for alar defects insisting on the design of medially based flaps.. To show the technique and practical application for this kind of reconstruction.. The bi- and trilobed flaps are useful for defect repair between the lateral nasal tip and the distal ala. We observed that in most cases the flap based medially respects anatomical subunits better than the laterally based flap for medium-sized defects of the distal ala of the nose.. I suggest that the bi- and trilobed flaps for repair of the lateral tip/distal ala should more often be medially based. This flap has a specific indication and precise advantage compared to other reconstructions, especially to the laterally based multilobed flaps in this specific indication.

Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

The aim of this study was to perform a systematic literature review of Merkel cell carcinomas (MCCs) originating exclusively in the ear, nose and throat (ENT) district. An appropriate string was run on PubMed to retrieve articles dealing with ENT presentations of MCC. A double cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. In total, 43 articles were finally included in the study, describing 51 cases of MCC involving the ENT region: 22/51 (43%) cases involving the ear; 20/51 (39%) cases involving the mucosal sites; 9/51 (18%) cases involving other ENT regions. Patients with mucosal site involvement showed a higher mortality rate from the disease (45%) in comparison with the other two groups, especially when compared with those patients having primary involvement of the ear (22%). The ENT specialist should suspect and consider MCC, especially in elderly patients presenting with a suspicious lesion of the auricular pavilion, so as to avoid misdiagnosis and delayed treatments.

Topics: Carcinoma, Merkel Cell; Ear; Humans; Mucous Membrane; Nose; Otorhinolaryngologic Neoplasms; Parotid Gland; Parotid Neoplasms; Pharynx; Skin Neoplasms

Alopecia present from birth includes a broad differential diagnosis and often represents a diagnostic and therapeutic challenge for the involved physician.. An initial correct diagnosis and classification is essential because structural hair defects may be the expression of a genetic disorder affecting hair growth, part of a congenital syndrome with accompanying hair malformations, or a marker for an underlying metabolic disorder and may impact the mental and physical development of a child. Pathological hair loss rarely occurs in the first year of life; however, it may be a leading symptom of many congenital diseases.. In recent years, the clinical and microscopic features of hereditary hair shaft disorders have been characterized and classified. Furthermore, significant progress has been made in our knowledge of genes that control the normal development and differentiation of hair follicles, and thus the research is to define and classify the hair disorders within a genetic basis.. In this article we discuss several types of genotrichosis and provide a practical classification based on their clinical features.

Topics: Alopecia; Aneurysm; Carcinoma, Basal Cell; Child; Cleft Lip; Cleft Palate; Deafness; Ectodermal Dysplasia; Eczema; Facies; Fingers; Growth Disorders; Hair Diseases; Hallermann's Syndrome; Histiocytoma, Benign Fibrous; Humans; Hypotrichosis; Ichthyosis; Intellectual Disability; Keratitis; Langer-Giedion Syndrome; Microcephaly; Nose; Skin Diseases, Genetic; Skin Neoplasms

--Skin cancer of the face is the most prevalent type of cancer. The large increase of the incidence of this type of cancer in recent years has resulted in an increase of skin cancer resections in the face. --Nasal defects are the most challenging of these facial defects. Nasal reconstruction requires reconstruction of three tissue layers: the inner mucosal lining, supporting structures (cartilage or bone) and the outer cutaneous lining. --The new inner lining should consist of well-vascularized thin tissue to prevent rejection of cartilage or bone in the supporting layer. For example, septal mucosa or skin can be used in various ways to reconstruct the inner lining. --The new supporting structures, consisting of transplanted cartilage or bone, should be strong enough to prevent contraction of the soft tissues--inner and outer lining--during wound healing. --The outer lining is reconstructed per subunit of the nose, e.g. nostril, ala nasi or ridge of the nose. Usually a paramedian forehead flap is used for the reconstruction of the outer lining.

Topics: Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Surgery on the nose is inseparable from the practice of dermatology. Extensive training and experience is required to account for the nose's unique role in determining individuality, its function as an airway, and its predilection for hosting aggressive tumors. This overview of anatomy and general surgical principles provides the novice with a foundation on which to build and the experienced practitioner a review of pertinent literature.

Topics: Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms

We report a case of an extremely rare histologic combination of pilomatrix or pilomatrical carcinoma with admixed melanocytes within the same tumor mass. Pilomatrix carcinoma is a neoplasm of low-grade malignancy that is characterized by a tendency for recurrence but low risk of metastasis. A 77-year-old male presented with a nodule on the bridge of the nose that was excised. Histologically, it was typified by asymmetry and poor circumscription, the presence of several variably sized and shaped basaloid aggregations, and surface ulceration. The tumors were composed of pleomorphic basaloid cells with prominent nucleoli and frequent mitoses (some of which were atypical) accompanied by central areas with keratotic material, shadow cells, and foci of necrosis. In addition, intermingled with the pilomatrix carcinoma, several easily identified pigmented cells with dendritic processes were present singly and as small aggregates. There was no atypia associated with the melanocytic component. Immunohistochemistry revealed the CK14 to be positive mainly within the keratinizing and the squamous epithelial elements of the tumor. The melanocytic component was strongly immunoreactive for S100, melanoma cocktail (HMB45 and Melan-A), and microphthalmia transcription factor. Pilomatrix carcinoma with melanocytes should be distinguished from the conventional pilomatrixoma with pigmentation, melanocytic matricoma, melanoma, and pigmented basal cell carcinoma with matrical differentiation. Clinicians and pathologists should be aware of the occurrence of pilomatrix carcinoma with melanocytes because of its potential for diagnosis as melanoma. This peculiar lesion recapitulates the intimate relationship existing between matrical epithelium and melanocytes in the embryonal hair follicle or in the anagen stage of the hair cycle. It is possible that sun damage played a role in stimulating migration of melanocytes among matrical cells in this case.

Topics: Aged; Biopsy, Needle; Carcinoma, Skin Appendage; Diagnosis, Differential; Follow-Up Studies; Hair Diseases; Humans; Immunohistochemistry; Male; Melanocytes; Neoplasm Staging; Nose; Pilomatrixoma; Risk Assessment; Skin Neoplasms; Treatment Outcome

The bilobed transposition flap has earned its reputation as a reliable and predictable flap, offering aesthetically appealing reconstructive results on difficult nasal defects. Several modifications to the bilobed technique have been made in recent years and there is a tendency towards bigger flaps executed at non-nasal locations. This review describes the development since Esser's original design, and summarizes present knowledge on bilobed flap repair. Furthermore, insight is offered into the latest indications for non-nasal reconstructions.

Topics: Carcinoma; Carcinoma, Basal Cell; Face; Facial Neoplasms; Forearm; History, 20th Century; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Soft Tissue Neoplasms; Surgery, Plastic; Surgical Flaps

This article reviews the indications and techniques for performing a bilobed flap for reconstruction of surgical wounds. Various examples of surgical defects where a bilobed flap can be used are shown. Possible complications and pitfalls are also reviewed.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear, External; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Nasal reconstruction can be challenging due to the complex nature of multiple cosmetic units and functional considerations. This article discusses single- and two-staged melolabial flap repairs for nasal reconstruction following removal of skin cancers.

Topics: Humans; Lip; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

As dermatologists and plastic surgeons have focused more effort on nasal repair, the dorsal nasal flap has been revitalized as an elegant repair for distal nasal defects. Small modifications of the flap provide for flexibility in execution. The viability of the dorsal nasal flap are unparalleled. When properly designed and executed , the dorsal nasal flap can reproducibly succeed in the repair of many challenging distal nasal wounds.

Topics: Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

The nasal ala and helical rim of the ear are common sites for the development of skin neoplasms. Removal of skin cancers from these aesthetically delicate areas may leave defects that free skin grafts alone may not adequately repair. The contractural forces of scarring within and around the skin graft during healing may produce elevation or notching of the rim and may lead to functional compromise. The use of a composite graft or the inclusion of a free cartilage graft in conjunction with a skin graft or flap repair can provide structural support, which may help to prevent undesirable outcomes. This article focuses on the use of composite or free cartilage grafts harvested from the ear to repair nasal alar or helical rim defects within a single surgical session. Preoperative considerations, surgical technique, and postsurgical complications are discussed.

Topics: Cartilage; Ear; Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms

The Koebner phenomenon, also known as the isomorphic response, is the development of preexisting skin disease following trauma to uninvolved skin. Various cutaneous disorders have been described to arise at surgical wounds and scars. Moreover, dermatologic procedures, such as cold-steel and laser surgery, can evoke koebnerization.. To describe a case of pemphigus foliaceus arising in postoperative wounds and to present a review of dermatologic disorders triggered by surgical procedures.. We report a case of pemphigus foliaceus initially presenting at sites of Mohs' micrographic surgery, shave biopsy, and cryotherapy and, subsequently, at a nonsurgical site. We reviewed the English literature in MEDLINE from November 1955 to April 2004 for reports of Koebner and related phenomenon following surgical procedures.. To our knowledge, this is the first reported case of pemphigus foliaceus erupting at surgical and cryotherapy wounds. The clinical appearance can mimic wound infection. In addition to inducing preexisting disease, cutaneous procedures can also trigger the onset of new disease, which can either be limited only to the surgical site or subsequently become generalized.. Postoperative Koebner or related responses should be included in the differential diagnosis of poorly healing surgical wounds. Skin biopsies for histopathology and immunologic studies may be necessary for definitive diagnosis and optimal management.

Topics: Aged; Carcinoma, Squamous Cell; Cicatrix; Diagnosis, Differential; Female; Humans; Nose; Pemphigus; Postoperative Complications; Skin Neoplasms; Surgical Wound Infection

Nasal reconstruction is a challenging yet rewarding endeavor. Repair of nasal defects requires an appreciation of variations in nasal skin thickness and the influence of these differences on potential reconstructive methods. Multiple factors help determine the optimal method of repair, including the size of the defect relative to the amount of remaining skin, the depth and location of the defect, and the strength of the underlying nasal framework. Maintaining symmetry, contour, and function is essential for a successful nasal reconstruction.

Topics: Humans; Mohs Surgery; Nose; Nose Neoplasms; Patient Selection; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Suture Techniques

There are several options for closure of a given surgical defect after tumor extirpation is confirmed. Flap reconstruction is one of these options.. The purpose of this article is to introduce the three basic types of flap movement: advancement, rotation, and transposition.. Five similar defects located on the nasal sidewall were repaired, each using a different flap design.. The optimal flap design for a given defect on a particular patient is based on the answers to a series of questions: Where is the available tissue reservoir? How can tissue be mobilized from the reservoir to cover the defect? How do the resulting tension vectors affect critical structures? Where are the final incision lines?. Many factors must be evaluated before determining a method of reconstruction. Flap reconstruction requires a thorough understanding of anatomy and tissue movement.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Although the bilobed transposition flap's utility in the reconstruction of difficult facial surgical wounds is often praised, the complicated design of the flap can produce unacceptable esthetic results if the nuances of flap design and execution are not properly understood.. To review the historical development of the bilobed flap and to offer contemporary suggestions on how to manipulate the flap's design to improve the flap's performance.. Illustrative case examples of bilobed flap successes and failures are appropriately and thoroughly examined.. The proper use of the bilobed flap completely depends on understanding the design modifications of the flap that can impact the flap's final appearance.. The bilobed flap, with its complicated design and requirement of meticulous operative technique, introduces tremendous opportunities for esthetic misadventure. Nonetheless, the flap, when properly constructed, deserves its reputation as the reconstructive flap of choice for many difficult wounds, particularly those wounds located on the distal nose.

Topics: Humans; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Transposition flaps are powerful reconstructive tools that are frequently called on in cutaneous reconstruction. Transposition flaps tap into adjacent areas that may have relative laxity while redirecting the vectors of tension during closure.. As with the closure of any surgical defect, the goal is to achieve the best possible functional and esthetic result.. Manual manipulation is used to "feel" for areas of relative laxity and test the effects of various tension vectors on adjacent structures. Every effort should be made to avoid distortion of the free margins of structures such as the nose and eyelids. Consideration must be taken to best camouflage incision lines within existing lines or creases, at the junction of cosmetic units, or at least parallel to lines of relaxed skin tension.. A complete knowledge of the possible variations and modifications of transposition flaps can help fine-tune the execution of the flap to provide the patient with the best possible result. Good surgical technique and proper wound eversion through meticulous suture placement also help tremendously in consistently attaining esthetically pleasing results. At the surgical bedside, an artistic eye should meet the science of cutaneous biomechanics.

Topics: Humans; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Staged interpolation flaps are priceless options in skin cancer reconstruction. Their value lies in their flexibility, reach, reliability, and ability to repair distant, complex facial defects. Familiar interpolation flaps to dermatologic surgeons include the paramedian forehead flap, cheek-to-nose interpolation flaps, and auricular staged flaps.. In this special reconstructive issue, the paramedian forehead flap is discussed separately. This article highlights the cheek-to-nose and auricular interpolation flaps as applied to skin cancer defects. Design considerations, anatomic basis, execution, and the distinctions of each repair are presented.. Patients with facial defects from Mohs micrographic surgery serve to illustrate the surgical techniques of each repair.. With meticulous planning and thoughtful execution, cheek-to-nose and auricular staged flaps are capable of restoring both function and cosmesis. Several surgical stages are necessary, and an adequate supporting infrastructure is essential for an optimal outcome.. Skin cancer patients with complex facial wounds from Mohs micrographic surgery may be assured of the highest possible cure rate. Further, their esthetic and functional reconstructive goals may be achieved with staged flaps for the nose and ear.

Topics: Cheek; Ear Cartilage; Humans; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

The paramedian forehead flap is the ultimate reconstructive method for repair of extensive nasal defects. Changes in technique have resulted in the evolution of the modern-day forehead flap, which is a streamlined, efficient, reliable flap that can be counted on to provide superior function and cosmesis in the reconstruction of large nasal defects.. Consistent success in the execution of a forehead flap hinges on a careful stepwise approach to the defect, the patient, and the surgical technique. Characterization of these steps was undertaken to assist the surgeon in achieving consistent post- operative results.. The process of executing a paramedian forehead flap beginning with preoperative assessment through the intraoperative procedure and culminating in the postoperative care is elucidated and discussed.. Through thoughtful planning and correct execution of technique, very large nasal defects are reconstructed, with excellent functional and esthetic results. Specific examples illustrate the range of approaches that can be used to address a variety of nasal tissue loss.. With careful attention to the reconstruction of all components of a nasal defect, a forehead flap can restore virtually any large nasal defect with excellent functional and cosmetic results. The skill sets that help optimize the process of nasal reconstruction are important to acquire. With careful planning and surgical finesse, forehead flaps can often result in nearly imperceptible restoration of the nose.

Topics: Forehead; Humans; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Skin grafting has evolved in the past centuries to encompass numerous well-established reconstruction techniques that are uniquely able to restore structure, function, and cosmesis to a variety of surgical wounds.. To provide a detailed overview of the general principles of skin grafting geared for the dermatologist and the dermatologic surgeon.. Comprehensive review of the literature.. A summary of the different applications and techniques of full- and split-thickness skin grafts, free cartilage grafts, and composite grafts is presented. Indications, advantages, disadvantages, techniques, and complications are discussed in depth.. Skin grafting is a dynamic and versatile method of cutaneous reconstruction that can be accomplished successfully with a thorough understanding of the principles and techniques of grafting.

Topics: Ear Cartilage; Humans; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Skin Transplantation

Reconstructive procedures performed on sebaceous nasal skin are prone to partial flap necrosis, scar spread and inversion, and tissue mismatch. An ideal repair would optimize vascular integrity, minimize closure tension, and use adjacent tissue.. The purpose of this article is to describe a flap design and dynamics that permit satisfactory reconstruction of small- to medium-sized defects on nasal sebaceous tissue.. A modified advancement flap is described that may be used on central and off-midline defects of the nasal tip.. Use of the modified advancement flap resulted in good cosmetic results with few adverse postsurgical events.. The modified advancement flap satisfies the requirements of a hardy blood supply, minimization of closure tension, and use of adjacent tissue. The surgical results are predictable and rarely associated with complications.

Topics: Humans; Nose; Rhinoplasty; Skin Neoplasms

Angiosarcoma is an aggressive neoplasm that predominantly affects elderly patients. Most cases appear on the scalp and face de novo; however, trauma, longstanding lymphedema, and irradiation are predisposing factors. Management includes a multidisciplinary team and may involve a combination of surgery, radiation, and chemotherapy tailored to the patient's age and associated comorbidities.

Topics: Aged, 80 and over; Diagnosis, Differential; Hemangiosarcoma; Humans; Male; Nose; Radiotherapy, Adjuvant; Skin Neoplasms

There are a number of reports in the literature of patients developing thrombotic events after stopping medically necessary antiplatelet and antithrombotic agents.. The objective was to determine whether discontinuation of aspirin taken for primary prophylaxis contributes to the development of thrombotic complications in patients undergoing dermatologic surgery.. A case is reported and the literature is reviewed.. We present the first reported case of a postoperative thrombotic event following dermatologic surgery in a patient withholding aspirin that was taken for primary prophylaxis.. We believe that the available data make it difficult to implicate aspirin discontinuation in the development of each thrombotic event, given the high baseline risk of thrombotic events in the Mohs surgery patient population and the low risk of developing such events when medications are withheld perioperatively.

Topics: Aged; Aspirin; Carcinoma, Basal Cell; Diagnosis, Differential; Drug Administration Schedule; Humans; Male; Mohs Surgery; Nose; Perioperative Care; Platelet Aggregation Inhibitors; Postoperative Complications; Skin Neoplasms; Stroke

Although it has been established that basal cell carcinoma is an uncommon diagnosis in black patients, the morpheaform subtype is very rare among these individuals.. The objective is to present two cases of morpheaform basal cell carcinoma in African-American patients.. This is a case series and a literature review using the Ovid Medline Database. Key words used in the search include "basal cell carcinoma," "African American," "black," "African," "negros," "morpheaform," "sclerosing," "fibrosing," and "scar-like basal cell carcinoma." The Ovid Medline Database was searched from 1966 to present and was restricted to the English language.. A review of the Emory Dermatology clinic charts from 1989 to 2004 revealed two black patients with morpheaform basal cell carcinomas.. Although extremely rare, morpheaform pattern basal cell carcinoma must be considered in the differential diagnosis for black patients presenting with nonhealing lesions.

Topics: Aged; Aged, 80 and over; Black People; Carcinoma, Basal Cell; Diagnosis, Differential; Female; Humans; Middle Aged; Nose; Skin Neoplasms

Cutaneous metastases from carcinoma are relatively uncommon in clinical practice. Metastasis to skin sites from squamous cell carcinoma of the mucosa of the head and neck are also very rare. However, skin metastases may be the first clinical evidence of the malignant disease or its loco-regional recurrence. Early recognition of skin metastasis can lead to an accurate and prompt diagnosis and timely treatment. Patients with skin metastases have very poor prognosis. We report on four such patients, one of them with multiple skin metastases from the squamous cell carcinoma in the cervical part of the esophagus above and below the level of the diaphragm. In reviewing the literature, only two cases of solitary skin metastases below the diaphragm from laryngeal squamous cell carcinomas have been reported

Topics: Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Leg; Male; Middle Aged; Nose; Skin Neoplasms; Thorax

Invasion of squamous cell carcinoma of the head and neck into cutaneous nerves is rare and can easily be missed. Perineural outgrowth into cerebral nerves may result in severe pain or neurological disturbances. In addition, these carcinomas more often recur or metastasize and therefore are associated with a poor prognosis.. We report on two patients with squamous cell carcinoma of the dorsum of the nose and lower lip exhibiting neurotropic growth.. Histology showed pleomorphic keratinocytes growing deep into the subcutaneous tissue and bone, respectively. The presence of few pleomorphic keratinocytes could be only confirmed by immunohistochemistry, though indicated by a perineural lymphocytic infiltrate. In both patients, several re-excisions were necessary to achieve cure.. In neurotropic squamous cell carcinoma a consequent radical micrographic surgery as well as neurological and radiological investigations are mandatory. We also review the literature.

Topics: Aged; Biomarkers, Tumor; Biopsy; Carcinoma, Squamous Cell; Humans; Immunoenzyme Techniques; Lip; Lip Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Nerve Fibers; Nose; Nose Neoplasms; Skin; Skin Neoplasms

Because the nose is a very prominent aesthetic feature of the face, wounds located here are particularly challenging from a reconstructive perspective. Poor tissue availability and the potential for introducing anatomic distortion certainly increase surgical complexity. There are common misconceptions regarding nasal reconstruction that may impede the physician's ability to deliver optimal care. Understanding that these commonly held assumptions about nasal wound repair are incorrect should increase the surgeon's nasal reconstructive abilities. The basic principles of reconstructive surgery are not uniquely applicable to the repair of nasal defects; the consequences of surgical misjudgments on the nose are simply magnified in comparison to surgical problems in other less visually prominent locations. To handle nasal surgical wounds with expertise, the dermatologic surgeon should first realize that there are common misconceptions that often hinder effective clinical decision making. By realizing that these incorrect assumptions can reduce success in nasal reconstruction, the surgeon should be able to more appropriately select nasal repair procedures that will accomplish the common goals of any facial reconstructive surgery: to preserve function, to restore appearance, and to minimize surgical risk.

Topics: Carcinoma, Basal Cell; Humans; Nose; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Surgical Flaps

A case of angiosarcoma arising from the nose of a 69-year-old man is presented in this report. The patient was treated with a combination of recombinant interleukin-2 (rIL-2, Celeuk), electron beam irradiation, and surgery. He died 27 months after diagnosis, but there was no apparent remote metastasis.

Topics: Aged; Biopsy, Needle; Combined Modality Therapy; Fatal Outcome; Hemangiosarcoma; Humans; Immunohistochemistry; Interleukin-2; Japan; Male; Nose; Radiotherapy, Adjuvant; Skin Neoplasms; Surgical Procedures, Operative

Pai syndrome is a rare congenital disorder first described in 1987. The main clinical features of the syndrome include median cleft of the upper lip, intra-cranial lipoma, and cutaneous polyps. Only four cases have been described previously. This is the fifth who is a twin of Arabian descent to be reported. Full description of the clinico-pathological features and a review of the relevant medical literature is presented. To the best of our knowledge, this is the first case of Pai syndrome in a twin in the English literature.

Topics: Biopsy, Needle; Brain Neoplasms; Cleft Lip; Female; Follow-Up Studies; Humans; Infant, Newborn; Lipoma; Magnetic Resonance Imaging; Nose; Polyps; Skin Neoplasms; Syndrome

Merkel cell carcinoma (MCC) is an uncommon, potentially lethal, cutaneous tumor that mainly occurs in sun-exposed skin of the head and neck area of the elderly. We report a case of MCC presenting as a 2-mm crusted erosion on the nose of an elderly patient, the smallest MCC reported thus far in the literature. The optimal management of MCC has not been clearly established. In view of its high local recurrence rate, predilection to metastasis, and significant mortality, aggressive treatment has been advocated. Identification of this tumor at such a small size posed a management dilemma because of lack of prospective treatment data involving biologic markers of prognostic significance for MCC.

Topics: Aged; Biopsy; Carcinoma, Merkel Cell; Dermatologic Surgical Procedures; Humans; Immunohistochemistry; Male; Mohs Surgery; Nasal Mucosa; Nose; Nose Neoplasms; Skin; Skin Neoplasms

Cutaneous metastatic disease is a prognostically important diagnosis. We report the case of a 64-year-old man who had an uncommon histologic type of lung cancer--a large cell undifferentiated carcinoma, which was metastatic to the skin of the nose. The relative frequency of cutaneous metastasis is similar to that of primary cancers. Cutaneous disease as the first sign of metastasis is most often seen in cancer of the lung. However, its appearance as a large tumor on the nose, which was observed in this case, is unusual.

Topics: Carcinoma, Large Cell; Diagnosis, Differential; Humans; Lung Neoplasms; Male; Middle Aged; Nose; Skin; Skin Neoplasms; Treatment Outcome

A 4-year-old boy presented with a 6-month history of a red papule on the nasal septum. Physical examination was otherwise unremarkable. A biopsy specimen showed an epithelioid sarcoma characterized by nodular collections of epithelioid tumor cells with central, tumor cell necrosis. By immunohistochemistry the tumor cells were positive for cytokeratin, epithelial membrane antigen, vimentin, and CD34, but negative for S-100, CD31, factor VIII-related antigen, CD68, actin, desmin and myoglobin. Epithelioid sarcoma is an uncommon tumor of uncertain histogenesis that typically arises in the extremities of young adults. Both the age of our patient and the location of his tumor are unusual, emphasizing the spectrum of presentations that may occur with epithelioid sarcoma. Epithelioid sarcoma should be considered in the differential diagnosis of granulomatous diseases and epithelioid tumors of children, even in unusual locations.

Topics: Antigens, CD34; Biomarkers, Tumor; Child, Preschool; Diagnosis, Differential; Humans; Immunohistochemistry; Keratins; Male; Mucin-1; Neoplasm Proteins; Nose; Sarcoma; Skin Neoplasms; Vimentin

Perifollicular fibroma (PFF) is a rare cutaneous hamartoma that shows differentiation to the connective tissue sheath of the hair follicle. It may be solitary or multiple; the latter has been suggested to exhibit autosomal dominant inheritance and association with colonic polyposis. We report a 72-year-old Japanese female with multiple PFF on the face, possibly familial, who developed colon cancer in addition to colonic polyps.

Topics: Adenocarcinoma; Aged; Colonic Neoplasms; Colonic Polyps; Female; Hamartoma; Humans; Nose; Skin Neoplasms

Diseases from the major pathophysiological subgroups, including inflammatory, infectious, neoplastic, autoimmune, and metabolic disorders, can present in a very similar clinical manner. The importance of generating a broad differential diagnosis is supported by a case in which an 80-year-old white man presented with a verrucous plaque on the tip of his nose. The appropriate differential diagnosis for such a lesion as well as an overview of the disease diagnosed, North American blastomycosis, is presented.

Topics: Aged; Aged, 80 and over; Blastomycosis; Diagnosis, Differential; Humans; Male; Nose; Skin Neoplasms

The association between cutaneous granular cell tumors and systemic defects is extremely rare, this being the tenth case reported in the literature. The reported defects in the literature include lentiginosis, face and skull alterations, heart defects, muscular and neural pathologies, among other sporadic defects in other organs. The patients do not present visceral granular cell tumors.. An 11-year-old girl had 124 skin granular cell tumors associated with face and skull defects, pulmonary stenosis, EEG and other neurologic alterations, diffuse muscle hypotonia, and an excess of finger joint mobility.. The combination of multiple cutaneous granular cell tumors with repeated alterations in other organs seems to be more than simply coincidental, thus suggesting a syndromic separate entity.

Topics: Cell Nucleus; Child; Collagen; Cytoplasm; Elastic Tissue; Face; Female; Granular Cell Tumor; Humans; Lip; Nose; Palate; Skin Neoplasms

Advanced carcinoma of the external nose is almost always associated with prior inadequate therapy. The first principle, therefore, in managing cutaneous malignancies of the nose is to achieve adequate tumor-free removal at the initial treatment. Recurrent carcinoma of the nose may require either hemirhinectomy or total rhinectomy to achieve tumor control.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Male; Nose; Nose Neoplasms; Prostheses and Implants; Rhinoplasty; Skin Neoplasms; Treatment Outcome

A twenty-seven-year-old white woman presented with a basal cell carcinoma at the former site of a strawberry hemangioma. The strawberry hemangioma had been treated in infancy with dry ice. The lesion spontaneously regressed and left no visible scar. To our knowledge, this is the first reported association of basal cell carcinoma and strawberry hemangioma.

Topics: Carcinoma, Basal Cell; Female; Follow-Up Studies; Hemangioma; Humans; Infant; Neoplasms, Multiple Primary; Nose; Skin Neoplasms

Cancer of the nasal skin is usually well-circumscribed, superficial, and has an excellent prognosis. However, a small number of aggressive lesions require a partial or total rhinectomy. We retrospectively reviewed patients seen at the M.D. Anderson Cancer Center between January 1, 1970, and December 31, 1980, for nasal cancer. There were 147 patients identified as requiring full-thickness nasal resections, of whom 68 (46.3%) required a hemi- or complete rhinectomy. Lesions requiring extensive rhinectomy usually involved the ala or were recurrent multicentric, squamous cell carcinomas greater than 4 cm. These patients had significantly poorer prognoses than the group in general. Recurrence developed in 45 patients (30.6%), and two thirds of all recurrences were seen within 2 years. In this series, the histology of the malignancy and its size, in the case of large basal cell carcinomas, were both predictive of a poor prognosis. Only the primary site was significant in predicting recurrence, whereas tumor size and histology were significant predictors of the need for an extensive rhinectomy. Delayed reconstruction is recommended in patients who are in poor health and have large recurrent lesions that are multicentric or involve the ala or dorsum. The timing of reconstruction is individualized, but a 2-year wait after surgery is recommended. Prosthetic rehabilitation is a good interim measure.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Nose; Nose Neoplasms; Prognosis; Skin Neoplasms

A subgroup of midfacial basal and squamous cell carcinomas invade extensively into the surrounding soft tissues and at times into bone, cartilage, and the nearby cavities. Their management can be optimized by using the combined skills of the Mohs micrographic surgeon and the head and neck surgeon. Relevant tumor biology and anatomy of this area are presented as a background for the discussion of the mechanics involved in tumor extirpation. Reconstructive philosophies and alternatives are reviewed.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Male; Microsurgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgery, Plastic

Five cases of spectacle-frame acanthoma are reported; four were retro-auricular (three unilateral; one bilateral) and one was present on the left side of the nose. Clinical aspects of the lesions are described by the light of all the other cases that have been previously reported in the literature. Histopathological features are compared to those encountered in chondrodermatitis nodularis helicis for which a frictional origin may also be suspected. In the vast majority of cases, spontaneous resolution is obtained when responsible spectacle frames are removed whereas a few lesions persist indefinitely despite of the fact that corrective measures are applied, on the contrary to what has been reported in previous papers. Apart from removing spectacles, these few cases needed surgical excision for a complete cure. Anatomo-clinical confrontations seem to indicate that those persistent lesions are completely fissured acanthomas.

Topics: Adult; Dermatitis; Diagnosis, Differential; Ear; Ear Diseases; Eyeglasses; Humans; Male; Middle Aged; Neck; Nose; Papilloma; Skin Neoplasms

Topics: Acne Vulgaris; Adult; Carcinoma, Basal Cell; Dermatitis; Diagnosis, Differential; Erythema; Exanthema; Eye Manifestations; Female; Humans; Lupus Vulgaris; Male; Middle Aged; Nose; Rosacea; Sarcoidosis; Skin Neoplasms; Telangiectasis

Topics: Adult; Aged; Aged, 80 and over; Bandages; Esthetics; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Prospective Studies; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Surgical Wound; Time Factors; Treatment Outcome

Total excision of congenital melanocytic nevi (CMN) is not always feasible. We here present our experience of using carbon dioxide laser and Q-switched neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser to treat nodular CMN of the nasal ala. Q-switched Nd:YAG laser and/or carbon dioxide laser were used to treat eight cases of nasal ala nodular CMN. Carbon dioxide laser was utilized to ablate all visible melanocytic tissue within one session. Ablation was performed so as to reproduce the original anatomical contours as closely as possible. Recurrences were treated in the same way. Q-switched Nd:YAG laser was also used to irradiate all target lesions to achieve the desired end point within one session. The intervals between treatments were at least 8 weeks. Recurrence of melanocytic tissue, scar formation, pigmentation, depigmentation, and the degree of patient satisfaction were recorded at every visit. Two of the eight patients were treated with Q-switched Nd:YAG laser. Although, the lesion lightened in one of them, the hyperplastic tissue persisted. Eventually, these two patients, along with the remaining six patients, were successfully treated with a carbon dioxide laser. We recommend carbon dioxide laser treatment for nodular nasal CMN. This simple treatment does not involve skin flap transplantation and has good cosmetic outcomes. Although Q-switched Nd:YAG laser does lighten some nasal nodular CMNs, it does not eradicate the hyperplastic tissue, and is therefore not an effective treatment for nodular nasal CMN.

Topics: Adolescent; Child; Cicatrix; Female; Humans; Laser Therapy; Lasers, Gas; Lasers, Solid-State; Male; Nevus, Pigmented; Nose; Patient Satisfaction; Skin Neoplasms; Treatment Outcome; Young Adult

"Pincushioning" is a complication of post-surgical scarring following use of transposition flaps particularly when surgery is performed on the nasal region. The transposition flap technique is very useful for the repair of certain defects of the tip of the nose, the medial canthus or of the ala nasi. The aim of this study is to define the clinical characteristics of this scarring dystrophy, which we propose to call "early hypertrophy scarring", to clarify the nature thereof and to assess the efficacy of intralesional injection of corticosteroids at the first signs of hypertrophy.. A prospective, open, non-comparative, single-centre study examined the clinical and histological characteristics of early hypertrophy scarring and the effectiveness of therapy with one or two injections of corticosteroids performed on the 15th day post-operatively and optionally repeated at D45 depending on the outcome. From January 2011 to January 2013, 12 consecutive patients with early hypertrophy scarring were included (ten men and two women - mean age: 64 years). All had undergone surgery for basal cell carcinoma under local anaesthesia with one-stage repair by means of a rhombic flap or a bilobed flap located in the nasal area. Scars were injected strictly intra-lesionally with triamcinolone acetate (40 mg/1 mL) until whitening occurred. A single injection was performed in three cases of rhombic flap while a second injection was given at D45 in the remaining nine cases.. Complete regression of the early hypertrophy scarring was obtained in ten of the 12 patients by D90. Incomplete regression was observed but with a marked improvement in the other two patients.. Early hypertrophy scarring is distinguished by its clinical characteristics of hypertrophic or keloid scars. Biopsy performed in two cases showed the fibrous but non-fatty nature of early hypertrophy scarring. Biomechanical factors particular to the nasal region and the transposition flap technique could account for the early and excessive collagen production causing early hypertrophy scarring. Early injection of corticosteroids, which was consistently effective in our study, could represent a simple treatment for early hypertrophy scarring, thus avoiding surgical correction. These preliminary results in a small number of patients require confirmation by a comparative, multicentre, prospective controlled study.

Topics: Aged; Carcinoma, Basal Cell; Cicatrix, Hypertrophic; Collagen; Delayed-Action Preparations; Female; Fibrosis; Humans; Injections, Intralesional; Male; Middle Aged; Nose; Nose Neoplasms; Postoperative Complications; Prospective Studies; Skin Neoplasms; Surgical Flaps; Triamcinolone; Wound Healing

The optimal method of reducing the risk of surgical site infection (SSI) after dermatologic surgery is unclear. Empiric, preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI. Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers. We compared the rates of infection in patients undergoing Mohs micrographic surgery (MMS) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization.. A randomized, controlled trial with 693 patients was conducted over a 30-week period at a single surgical practice. Patients were stratified into nasal carriers or noncarriers of S. aureus based on a preoperative nasal swab. Nasal carriers of S. aureus were randomized to receive topical decolonization with intranasal mupirocin twice daily plus 4% chlorhexidine gluconate body wash daily for 5 consecutive days before surgery or statim pre- and postoperative doses of oral cephalexin.. One hundred seventy-nine patients (25.8%) were identified as carriers of S. aureus. Ninety received topical decolonization, and 89 received oral antibiotics. These groups were compared with a swab-negative Mohs surgical cohort over the same time period. There were no significant differences between the groups in terms of demographic characteristics or comorbidities. Nine percent of patients receiving oral antibiotic prophylaxis and 0% receiving topical decolonization developed early SSI (p = .003).. In patients with demonstrable carriage of S. aureus, topical decolonization resulted in fewer SSI than in patients receiving perioperative oral antibiotics. Antibiotics should be reserved for clinically suspected and swab-proven infections rather than being prescribed empirically. Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS.

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Baths; Carrier State; Cephalexin; Chlorhexidine; Female; Humans; Male; Middle Aged; Mohs Surgery; Mupirocin; Nose; Skin Neoplasms; Staphylococcus aureus; Surgical Wound Infection

Full thickness grafts on the nose do not always heal without problems. Partial or entire necrosis of the graft is likely to lead to less favourable cosmetic results and prolonged wound care. No consensus exists as to the use of systemic antibiotics to increase the success rate of survival of a full thickness skin graft on the nose after non-melanoma skin cancer surgery.. The objective of the study was to evaluate the effect of systemic antibiotics on the survival of full thickness grafts on the nose.. We performed a randomized, controlled trial in which we compared azithromycin with standard treatment in 30 patients, who underwent a full thickness graft reconstruction of a surgical defect on the nose after surgery for non-melanoma skin cancer. Percentage survival of the graft was the main outcome measure.. A statistically significant difference in favour of the grafts treated with azithromycin was seen (P=0.002). Of all the variables analysed, only smoking had a significant negative effect on the survival of the graft.. Systemic antibiotics with an accurate bacterial spectrum should be advised in full thickness skin graft reconstruction after surgery for non-melanoma skin cancer of the nose. Smoking should be strongly discouraged.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Carcinoma, Basal Cell; Female; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Treatment Outcome

Full-thickness skin grafting following Mohs micrographic surgery (MMS) of the nasal tip and ala provides easy postoperative wound care and avoids functional impairment caused by wound contraction of the nasal ala free margins. Direct comparison of immediate and delayed skin grafting determined which offers greater success and defined factors contributing to success.. To determine if delayed or immediate full-thickness skin grafting results in better graft survival with improved function and appearance, and to identify the recipient bed characteristics, including the size of the wound, the proportion of the wound base having perichondrium, denuded cartilage, and granulation tissue, and graft survival for each technique.. We used a prospective study comparing 200 patients with wounds having a 3-5 cm2 surface area repaired immediately with a full-thickness skin graft (FTSG) to 200 patients with a delayed FTSG. The depth and diameter of the wound of the nasal ala and tip, and characteristics of recipient bed including size (cm2), location, proportion of wound base with perichondrium present, denuded cartilage, granulation tissue, and proportion of graft loss were the main outcomes measured.. Partial graft loss occurred in 11% of those having delayed skin grafts and 30% of those with immediate repair. Delayed grafting was associated with a larger wound surface area (P <.0001), more denuded cartilage (P =.017), greater exposed perichondrium (P <.0001), and less partial graft loss (P <.001). When partial graft loss occurred, the area of loss was smaller with delayed FTSG (P =.036). Contraction of the wound and subsequent nasal valve impairment occurred less often with delayed FTSG (P <.0001). Graft depression was significantly less with delayed FTSG of the ala (P <.0001) and also improved on the nasal tip (P =.47).. This prospective clinical trial of immediate and delayed FTSGs of the nasal tip and ala with denuded cartilage showed improved graft survival in cases where grafting was delayed for 12-14 days. During this period, substantial granulation tissue formed in the wound base. Assessment of the wound base and the presence of granulation tissue are key factors in the success of full-thickness skin grafting.

Topics: Aged; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Prospective Studies; Skin Neoplasms; Skin Transplantation; Time Factors

Alar batten cartilage grafts can restore form and function to a compromised ala, prevent stenosis of the nasal valve, and maintain unrestricted air movement. Soft tissue reconstructive options can be combined with alar batten grafts.. Our purpose was to analyze functional and cosmetic outcomes in a series of patients undergoing alar batten cartilage grafting.. We analyzed the functional and cosmetic outcomes of 25 patients in whom reconstruction involved alar batten cartilage grafts. Assessment included defect characteristics, function and cosmesis (rated by physician and patient), and complications.. Eighty-three percent of patients had good to excellent functional and cosmetic results by patient and physician assessment. Three patients were rated as having poor cosmetic results by the physician; all 3 patients graded these results as good. One episode of graft failure occurred, and recipient and donor site complications were minor.. Alar batten cartilage grafts appear to be an excellent option for reconstruction of substantial alar defects.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Graft Rejection; Graft Survival; Humans; Nose; Patient Satisfaction; Plastic Surgery Procedures; Skin Neoplasms

Topics: Adult; Humans; Keloid; Nose; Skin Neoplasms

Repair of excisional defects involving the nose and cheek requires thoughtful planning to maintain the natural contour of the anatomical sites and optimize cosmetic outcomes. We aim to demonstrate that a combination repair of defects involving the ala and nasolabial fold with a full-thickness skin graft and a local flap can be used with good cosmesis and minimal complications.. This is a case report of a patient with skin cancer on the left ala and left nasolabial fold who underwent Mohs micrographic surgery for tumor extirpation.. The patient and the Mohs surgeon reported satisfaction with the cosmetic and functional outcomes at the 6-month postoperative follow-up with no complications.. The use of a full-thickness skin graft from a standing tissue cone and a cheek crescentic advancement flap is a viable repair option for Mohs micrographic surgery defects involving the ala and nasolabial fold.

Topics: Humans; Mohs Surgery; Nasolabial Fold; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

The nose is a common site for skin tumors. The main arteries that supply the nose extend through the subcutaneous tissue. Submuscular dissection facilitates the design of safe, reliable musculocutaneous flaps that adapt well to the morphology of nasal defects. The diversity of these flaps makes them the first choice for reconstructing defects in more complex regions, such as the inner canthus of the eye and the nasal ala. We describe the surgical design of the procerus, V-Y nasalis, and lateral wall nasalis musculocutaneous flaps used to repair defects following tumor excision. The descriptions are illustrated by photographs taken by the authors during procedures and in cadaveric dissections.

Topics: Animals; Humans; Myocutaneous Flap; Nose; Nose Neoplasms; Plastic Surgery Procedures; Presbytini; Skin Neoplasms

Topics: Carcinoma, Squamous Cell; Humans; Nasal Cavity; Nose; Nose Neoplasms; Skin Neoplasms

The use of dermal matrices has shown to be reliable and less invasive than skin grafts or skin flaps for wound management. This case series reports the clinical outcomes of 5 patients with defects on the nose post-MMS managed using collagen-glycosaminoglycan silicone bilayer matrix.. Patient 1 had a BCC of the left nasal lateral sidewall, patient 2 had a BCC of the right nasal ala, patient 3 had a BCC of the nasal dorsum, patient 4 had a BCC of the left medial canthus, and patient 5 had a BCC of the left alar lobule of the nose. Layers of dermal matrix were stacked to augment soft tissue coverage in patient 5.. All patients had spontaneous epithelialization of the nose defects following dermal matrix placement. Time to healing ranged from 4 to 11 weeks after dermal matrix placement for defects ranging from 1.44 cm2 to 6.16 cm2. The covering was stable and resulted in satisfactory cosmesis at time of complete epithelialization.. Closure of post-MMS nasal defects using bilayer matrix represents a viable option and an advantage over alternative forms of surgical repair when considering cosmesis and patient satisfaction.

Topics: Collagen; Humans; Mohs Surgery; Nose; Nose Neoplasms; Retrospective Studies; Skin Neoplasms

Topics: Adult; Humans; Keloid; Nose; Skin Neoplasms

Reconstruction of a distal nasal defect is challenging due to poor skin mobility and the potential for nasal alar retraction. A trilobed flap can utilize more mobile proximal skin, increase the total rotational arc, and decrease the tension associated with flap transposition. However, the trilobed flap may not be ideal for distal nasal defects because each flap is designed using immobile skin, which may lead to flap immobility and free margin distortion. To overcome these problems, the base and tip of each flap were extended further from the pivot point than those of the conventional trilobed flap. Herein, we report the use of the modified trilobed flap to treat 15 consecutive cases of distal nasal defects that occurred from January 2013 to December 2019. The mean duration of follow-up was 15.6 months. All flaps survived completely, and satisfactory aesthetic outcomes were achieved. No complications such as wound dehiscence, nasal asymmetry, or hypertrophic scarring were observed. The modified trilobed flap is a simple and reliable treatment for distal nasal defects.

Topics: Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin; Skin Neoplasms; Surgical Flaps

Topics: Humans; Mohs Surgery; Nose; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Spindle cell-predominant trichodiscoma (SCPT) is a benign adnexal neoplasm, best categorized within the trichodiscoma-fibrofolliculoma continuum. SCPTs clinically present as dome-shaped papules usually on the face, particularly on the nose or the nasolabial fold. The SCPT variant has been described as a particularly cellular trichodiscoma composed of small interweaving fascicles and sheets of spindle cells. Identical lesions were previously referred to as neurofollicular hamartomas because of their predominantly fascicular stromal cellularity and focal S100 positivity. In this article, we report a rare variant of SCPT with a palisaded arrangement. The patient is a middle-aged man with no significant dermatologic history who presented with a skin-colored papule on the left nasal ala. It had been present for approximately 10 years with only minimal growth over that time. A biopsy was obtained. Histopathological analysis revealed a dermal papule composed of bland spindle cells arranged in a striking palisading pattern within a fibromyxoid stroma with associated peripheral hyperplasia of sebaceous glands. The palisaded pattern shared features reminiscent of Verocay bodies of a schwannoma. Immunohistochemical studies revealed stromal spindled cells with a strong and diffuse pattern of CD34 expression and absent S100 and SOX10 expressions. To our knowledge, only 2 cases of SCPT with a palisaded pattern have been presented. SCPT with a palisaded pattern is a rare histopathologic variant that may resemble a schwannoma but can be recognized by its strong epithelial components and immunohistochemical staining pattern.

Topics: Hair Diseases; Humans; Male; Middle Aged; Neurilemmoma; Nose; Sebaceous Glands; Skin Neoplasms

Although patient satisfaction with reconstructive outcomes after facial skin cancer resection is an important consideration in Mohs surgery, there is limited information evaluating this concern using validated patient-reported outcome tools.. To characterize predictors that may be associated with increased postoperative patient satisfaction with facial appearance after Mohs surgery using the FACE-Q/Skin Cancer survey, a patient-reported outcome tool that has been validated in various studies.. A total of 202 patients who underwent Mohs surgery for facial skin cancer at the Brigham and Women's Faulkner Hospital between April 2017 and November 2021 were included after completing the postoperative Satisfaction with Facial Appearance scale (FACE-Q scale).. Male patients were significantly more likely to have higher satisfaction scores compared with female patients (aOR 2.4, 95% CI 1.1-5.1). Increased preoperative facial satisfaction scores was directly correlated with increased postoperative facial satisfaction scores ( p < .01). Patients with tumors on the lower face/neck (aOR 3.88; 95% CI 1.4-10.7) had significantly greater satisfaction scores compared with those with tumors on their nose/nasolabial folds.. Potential interventions and counseling methods can be tailored toward specific patient populations with lower satisfaction scores to increase their overall satisfaction with reconstructive outcomes.

Topics: Facial Neoplasms; Female; Humans; Male; Mohs Surgery; Nasolabial Fold; Nose; Patient Satisfaction; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Cheek; Humans; Nose; Nose Neoplasms; Skin Neoplasms

Closure of the nasal skin defects that resulted from excision of the skin neoplasms represents a challenging problem in reconstructive surgery. Here, the use of the reading man procedure as a new alternative in reconstruction of the skin defects of the nose is presented.. In this procedure, 2 local flaps designed in an unequal Z-plasty manner are used. Defect coverage is achieved by transposing the first flap to the defect area, whereas the second flap is used for closure of the first flap's donor site. In last 10 years, this technique has been used for closure of the nasal skin defects that resulted from removal of skin cancers in 28 patients (15 men and 13 women) aged from 45 to 98 years. The defects were ranging between 1.5 and 3.1 cm in diameter.. In all patients, a tension-free 1-stage closure was obtained. There was no patient with dog ear formation and/or distortion of the mobile anatomical structures, such as nasal tip, alar lobules, and nostrils. All patients healed without complications. A mean follow-up of 52 months (8 months to 6.5 years) revealed satisfactory cosmetic results in all patients. No tumor recurrence was observed.. Using the advantage of extra tissue relaxation provided by an unequal Z-plasty, the reading man procedure seems to be a useful alternative for the closure of nasal defects with alike local skin. As a critical achievement, this procedure does not require excision of additional healthy tissue. Borrowing tissue from multiple directions, it avoids dog ear formation and distortion of the mobile anatomic structures.

Topics: Female; Humans; Neoplasm Recurrence, Local; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

The surgical repair of full-thickness defects involving the alae nasi is complex. Pedicle flaps such as frontal and nasolabial flaps can be used, but require several interventions with different techniques. In contrast, free flaps from the foot of the ear helix allow the three layers of the nasal wings to be reconstructed in a single operation. Nevertheless, in the classical approach, the vascular pedicle is short. Although some authors have proposed raising the flap in a retrograde manner, this still yields a relatively short pedicle with narrow vessels. In the companion paper, we demonstrated that a posterior auricular artery helix root free flap (PAAHF) can be harvested from the posterior auricular vessels, thus increasing the useful pedicle length. The case of a patient with basal cell carcinoma of the left ala is presented here. A right helix root free flap was anastomosed with the facial vessels at the left mandibular notch. This new flap overcomes the main limitation of the classical helix root flap, namely the length of the pedicle. It has all of the morphological qualities of the classical flap, but with simpler vascular assembly, since autologous venous grafts and complex anastomoses are not required.

Topics: Arteries; Free Tissue Flaps; Humans; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Skin Neoplasms

Nasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients' satisfaction after reconstruction for nasal defects following Mohs micrographic surgery.. Patients presenting with nasal nonmelanoma skin cancer at Memorial Sloan Kettering Cancer Center New York, USA and Catharina Hospital Eindhoven, Netherlands from April 2017 to November 2019 were asked to participate. Reconstruction type, complications, and patients satisfaction were assessed. Patients completed the FACE-Q Skin Cancer - Satisfaction with Facial Appearance scale (preoperative and 1-year postoperative) and the Appraisal of Scars scale (1-year postoperative).. A total of 128 patients completed the preand postoperative scales. There were 35 (27%) surgical defects repaired with primary closures, 71 (55.5%) with flaps, and 22 (17.2%) with full-thickness skin grafts (FTSG). Patients that underwent a flap or FTSG reconstruction had higher scar satisfaction scores than primary closures (p = 0.03). A trend was seen with patients following flap reconstructions scoring 7.8 points higher than primary closures and patients with upper nose defects scoring 6.4 points higher than lower nose defects. Males were significantly more satisfied than females. No significant difference was observed in the preoperative and postoperative facial appearance scores between the three groups (p = 0.39).. Patients are more satisfied in the long term with their scars after flap reconstructions compared to primary closures. Therefore, nasal skin reconstruction may not follow the traditional reconstructive ladder and more complex approaches may lead to higher long-term scar satisfaction.

Topics: Female; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

The aesthetic reconstruction of full thickness defects of the entire ala is difficult because of its complex tridimensional anatomy. The triplan reconstruction of this unit which includes: -a lining with a mucosal flap, -a sculptured cartilage framework imitating the anatomy of the opposite ala -and a skin coverage by an immediate defatted forehead flap, gives regularly a very good aesthetic results, superior to the ones obtained by other techniques.. From may 2008 to December 2020, 26 patients aged between 49 and 78 years old have benefited from this triplan aesthetic reconstruction after an excision of evolved basal cell carcinomas interesting the ala unit. The defects resulting were located in the entire ala with slight extension to the adjacent units. In all cases, the lining was reconstructed by the BURGET'S homolateral septal mucosal flap. The shape of the ala was obtained by a precise sculpture of conqual cartilage, taking the opposite ala as the model. The cutaneous coverage was provided by a paramedian forehead flap tailored exactly to the defect's size and immediately defatted.. With a mean follow up of 8 years, all the reconstructed ala were quasi symmetrical to the opposite ones with a very good shape of the new nostrils. No complications and no tumoral recurrence are reported.. This triplan reconstruction of the entire ala's defects is really aesthetic and gives a natural look for the lower third of the nose.

Topics: Aged; Carcinoma, Basal Cell; Esthetics; Humans; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms

A 68-year-old patient was referred to the dermatology clinic with a large destructive tumour on his nose. Due to COVID-19-related fear, he had avoided his regular dermatology appointments. Histopathology revealed a poorly differentiated squamous cell carcinoma. This case demonstrates the impact of delayed healthcare due to fear of COVID-19.

Topics: Aged; Appointments and Schedules; Carcinoma, Squamous Cell; COVID-19; Humans; Male; Nose; Skin Neoplasms

Topics: Humans; Nose; Skin Neoplasms; Ulcer

Basal cell carcinoma (BCC) is the most common skin cancer and originates from the basal layer of the epidermis. It is most common in the head and neck region. It usually grows slowly and rarely metastasizes. The gold standard treatment is surgical excision.. In this study, it was aimed to discuss the demographic and medical data of patients treated with the diagnosis of BCC.. Sixty-seven tumors of 55 patients who were operated for BCC in our clinic between 2016 and 2020 were retrospectively analyzed. Demographic and medical data were analyzed.. The tumor was most commonly localized to the nose. The most common (50%) histological type was the nodular type. Recurrence occurred in one of our patients (1.5%). Surgical margin positivity was observed in six patients.. Basal cell carcinomas are most common in the head and neck region. Its frequency increases with age and is more common in men. In our patients, 98.5% of the tumors were located in the head and neck, and 89.5% were over 60 years of age. Nodular is the most common type of BCC, and the most common nodular type was detected in our study. Surgical margin positivity is observed between 9% and 37.2% after surgery, and the recurrence rate is around 5%. In our study, surgical margin positivity was 9% and recurrence was 1.5%. Evaluating the excision margins carefully in a well-lit environment and taking into account cosmetic concerns, obtaining an adequately intact surgical margin in one go may lead to the ideal treatment result.

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Margins of Excision; Middle Aged; Neoplasm Recurrence, Local; Nose; Retrospective Studies; Skin Neoplasms

Nonmelanoma skin cancer is the most common cancer, typically growing in sun-exposed areas, such as the nose. After complete excision of the tumor, the subsequent scar may exhibit multiple complications that are easily noticeable and cosmetically unsatisfactory. When performing a revision of such a scar, using a single surgical technique may be insufficient; rather, the surgeon may need to carefully plan and utilize several techniques to achieve the best cosmetic outcome. Here, we report a case that demonstrates successful use of surgical defatting and Z-plasty techniques to revise a scar of the nasal dorsum that exhibited pincushioning and webbing.

Topics: Cicatrix; Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms

小丑鼻因位于鼻尖的结节状外观酷似小丑红色假鼻而得名，首次用于描述乳腺癌鼻尖转移的临床特征。关于卵巢癌鼻尖转移，目前中外文献报道仅1例。本文报道1例吉林大学中日联谊医院收治的卵巢癌鼻尖转移患者，介绍其病例特点及小丑鼻的相关诊治过程。.

Topics: Female; Humans; Nose; Nose Neoplasms; Ovarian Neoplasms; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Myocutaneous Flap; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Wound; Treatment Outcome

Topics: Carcinoma, Basal Cell; Cheek; Humans; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms

Topics: Carcinoma, Bronchogenic; Humans; Lung Neoplasms; Nose; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Lip; Lip Neoplasms; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Male; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Surgical Wound

Reconstruction of defects of nasal ala and dorsum after surgical excision presents a substantial challenge to dermatologic surgeons. Second intention healing is a simple and extremely useful method to optimize cosmesis after skin cancer removal.. This study reported the cosmetic outcomes after second intention healing of nasal ala and dorsum defects in Asians, and estimated the time to epithelialization and complete healing.. Fifteen defects (<1 cm in diameter) of the nasal ala and dorsum in 10 patients were allowed to heal by secondary intention. Cosmetic results were evaluated and the time to epithelialization and complete healing were recorded.. Cosmetic outcomes were good to excellent in 80% of the defects; defects of the dorsum showed poorer cosmetic results than defects of the ala. The wounds needed 5-17 days (mean 11.3; SD ± 4.18) to complete epithelialization and 10-24 days (mean 17.7; SD ± 4.85) to heal completely.. Second intention healing of small nasal ala and dorsum defects (<1 cm in diameter) in Asians produces satisfactory cosmetic results with a low complication rate.

Topics: Adult; Asian People; Child; Female; Humans; Male; Middle Aged; Nose; Re-Epithelialization; Retrospective Studies; Skin; Skin Neoplasms; Wound Healing; Young Adult

Topics: Blood Loss, Surgical; Hemostasis, Surgical; Humans; Mohs Surgery; Nose; Nose Neoplasms; Pressure; Skin Neoplasms

Topics: Forehead; Humans; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Aged, 80 and over; Cheek; Female; Forehead; Humans; Hutchinson's Melanotic Freckle; Mohs Surgery; Neck; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps; Surgical Wound; Treatment Outcome

Topics: Carcinoma, Basal Cell; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Microcystic adnexal carcinoma (MAC) is a low-grade adnexal carcinoma with controversial lines of differentiation. We present here an example of MAC showing histopathologic findings of germinative follicular differentiation in the form of solid aggregates of trichoblastoma intermingled with neoplastic aggregates of MAC. Immunohistochemical findings, showing positivity for PHLDA1 and negativity for BerEp4 in neoplastic aggregates of trichoblastoma, also supported a germinative follicular differentiation. Follicular differentiation in MAC supports an apocrine line of differentiation for this neoplasm.

Topics: Aged; Cell Differentiation; Humans; Male; Neoplasms, Adnexal and Skin Appendage; Nose; Skin Neoplasms

The purpose of this study was for the authors to describe their patient selection, surgical technique, and results with the alar rotation flap for surgical defects of the nasal ala.. The authors performed a retrospective analysis of all alar rotation flaps performed between June of 2006 and February of 2019. Three hundred ninety-four patients were identified, and follow-up encounters were reviewed to assess for complications and need for revision procedures.. The alar rotation flap was performed on 394 patients over a 13-year period. The mean defect size was 9.3 ± 2.8 mm by 7.2 ± 2.3 mm. Three hundred nineteen patients (81 percent) were evaluated postoperatively, with a mean average duration of follow-up of 2.3 years (range, 6 days to 11.9 years). Complications included hemorrhagic crust along the incision line [n = 9 (3 percent)], flap edema [n = 7 (2 percent)], internal nasal valve dysfunction [n = 3 (1 percent)], depressed surgical scar [n = 2 (1 percent)], hematoma [n = 1 (0.5 percent)], and paresthesia [n = 1 (0.5 percent)].. The alar rotation flap is a reliable one-stage flap for small- to medium-size partial-thickness defects of the nasal ala that can produce topographic restoration with minimal risk of aesthetic or functional complication.. Therapeutic, IV.

Topics: Aged; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Patient Selection; Postoperative Complications; Retrospective Studies; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Surgical Wound; Suture Techniques; Treatment Outcome

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Female; Follow-Up Studies; Humans; Male; Mohs Surgery; Neoplasm Invasiveness; Nose; Nose Neoplasms; Retrospective Studies; Skin Neoplasms

Topics: Calcinosis; Humans; Nose; Plastic Surgery Procedures; Silicones; Skin Neoplasms

Topics: Adult; Connective Tissue Diseases; Humans; Nose; Skin Neoplasms; Xanthogranuloma, Juvenile

Topics: Carcinoma, Basosquamous; Humans; Immunocompromised Host; Nose; Nose Neoplasms; Pandemics; Plastic Surgery Procedures; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Aged; Forehead; Humans; Male; Nose; Nose Neoplasms; Retrospective Studies; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Globus Sensation; Humans; Melanoma; Nose; Pharynx; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Esthetics; Humans; Mohs Surgery; Nose; Skin Neoplasms; Surgical Flaps; Surgical Wound; Treatment Outcome

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Nasal defects following Mohs resection are a reconstructive challenge, demanding aesthetic and functional considerations. Many reconstructive modalities are available, each with varying utility and efficacy. The goal of this study was to provide an algorithmic approach to nasal reconstruction and illustrate lessons learned from decades of reconstructing Mohs defects.. A retrospective review was conducted of consecutive patients who underwent nasal reconstruction after Mohs excision from 2003 to 2019 performed by the senior author (J.F.T.). Data were collected and analyzed regarding patient and clinical demographics, defect characteristics, reconstructive modality used, revisions, and complications.. A total of 2553 cases were identified, among which 1550 (1375 patients) were analyzed. Defects most commonly affected the nasal ala (48.1 percent); 74.8 percent were skin-only. Full-thickness skin-grafts were the most common reconstructive method (36.2 percent); 24.4 percent of patients underwent forehead flaps and 17.0 percent underwent nasolabial flaps. The overall complication rate was 11.6 percent (n = 181), with poor wound healing being most common. Age older than 75 years, defects larger than 2 cm2, and active smoking were associated with increased complication rates.. Nasal reconstruction can be divided based on anatomical location, and an algorithmic approach facilitates excellent results. Although local flaps may be suitable for some patients, they are not always the most aesthetic option. The versatility and low risk-to-benefit profile of the forehead flap make it a suitable option for elderly patients. Although reconstruction is still safe to be performed without discontinuation of anticoagulation, older age, smoking, and large defect size are predictors of complications.. Therapeutic, IV.

Topics: Age Factors; Aged; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Postoperative Complications; Retrospective Studies; Rhinoplasty; Risk Assessment; Risk Factors; Skin Neoplasms; Smoking; Surgical Flaps; Treatment Outcome

Topics: Adult; Aged; Carcinoma, Basal Cell; Esthetics; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Retrospective Studies; Skin Neoplasms; Surgical Flaps; Surgical Wound; Treatment Outcome; Wound Closure Techniques

The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae.. To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects.. A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS).. A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes.. The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.

Topics: Adult; Aged; Cicatrix; Esthetics; Female; Humans; Male; Middle Aged; Mohs Surgery; Myocutaneous Flap; Necrosis; Nose; Nose Neoplasms; Patient Reported Outcome Measures; Reproducibility of Results; Retrospective Studies; Rhinoplasty; Skin Neoplasms; Treatment Outcome

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Carboplatin; Carcinoma; Chemoradiotherapy; Dexamethasone; Diagnosis, Differential; Etoposide; Humans; Ifosfamide; Lymphoma, Extranodal NK-T-Cell; Male; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Aged; Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cryosurgery; Curettage; Female; Humans; Male; Melanoma; Mohs Surgery; Nose; Radiotherapy; Skin Neoplasms

Few studies exist that compare local flap repair designs either mathematically or clinically. Previous mathematical studies use a two-dimensional modeling approach, which is not suited to complex structures like the nose. To quantitatively analyze and compare flap designs for nasal repair using three-dimensional, photographic models. via a three-dimensional imaging system (Vectra M3, Canfield Scientific, Parsippany, NJ, USA), images were captured of actual post-Mohs nasal defects on 12 consecutive patients. Transposition, rotation, and advancement flap designs were designed and assessed based on tissue efficiency (E

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Esthetics; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Models, Anatomic; Mohs Surgery; Nose; Nose Neoplasms; Patient Care Planning; Photography; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Surgical Wound; Treatment Outcome

Nasal skin defect closures are challenging because the nose is a complex anatomic structure with several subunits, and the nasal tip and ala represent particularly difficult subunits to reconstruct. The traditional full-thickness skin graft (FTSG) is an easy and well-established method, but often results in undesirable outcomes in terms of the nasal contour caused by a lack of dermal tissue.. The purpose of the study is to report the outcomes of the simultaneous application of the acellular dermal substitute (Matriderm. Five patients with various nasal skin defects were treated with multilayered Matriderm grafts followed by FTSGs harvested from the pre- or postauricular region. Graft survival, scar quality, and patient satisfaction were evaluated and compared with 10 patients treated with conventional FTSGs.. One-stage Matriderm-aided FTSGs were well-taken in all cases. Scar quality in the Matriderm group (8.0 ± 1.9) was statistically superior to that in the FTSG only group (10.8 ± 1.7). The Matriderm-aided graft was also superior in patient satisfaction.. The multilayered application of Matriderm in combination with FTSG is a reliable method for covering nasal skin defects, especially in the thick skin zone of the tip and ala.

Topics: Cicatrix; Humans; Nose; Skin; Skin Neoplasms; Skin Transplantation

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Margins of Excision; Nose; Nose Neoplasms; Skin; Skin Neoplasms; Treatment Outcome; Tumor Burden

Basal Cell Carcinoma (BCC) is one of the most common human malignant neoplasms and is the most prevalent skin cancer in the United States with over four million new cases reported annually.1,2 Most BCCs arise in the skin from exposure to the sun’s ultraviolet radiation. However, it is possible for BCCs to present in sun-protected areas due to factors other than sun exposure. We present a case of a basal cell carcinoma located in the nasal vestibule. In presenting this case, we would like to emphasize the importance of attentive full skin examinations, both by physicians and patients, that include observation of sun-protected areas, as skin cancers such as basal cell carcinomas may occur in these unusual areas. In addition, BCCs have been reported in the literature to have occurred in the interdigital area of the foot, the female and male nipples, the axillae, and the genital and perianal areas.3,4,5,6,7,8 J Drugs Dermatol. 2020;19(3):333-334 doi:10.36849/JDD.2020.4517.

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Diagnosis, Differential; Humans; Male; Mohs Surgery; Nose; Skin Neoplasms; Sunlight

Topics: Aged; Female; Humans; Melanoma; Nose; Skin Neoplasms

To test if there are different outcomes in basal cell carcinoma for lesion size, histopathology, localization, and recurrence rates.. A total of 395 patients with BCC localized in the neck, nose and ear regions who were surgically treated in Latvian Oncology Centre between 2006-2011 were analyzed retrospectively. The data were analyzed using modified classification based on Clarks et al. (2014) and McKenzie et al. (2016).. Three hundred and ninety-five cases of BCC that were surgically treated in head and neck region were reviewed. Results were tabulated in four categories: anatomical region, histopathology, lesion size, and recurrence rates. Classification by anatomical region: 228 cases in the nose region, 82 cases in the neck region, 82 cases in the ear region. Classification by histopathology: 259 cases presented as low risk BCC [nodular, pigmented, adenoid, keratotic and cystic], 21 cases presented as superficial, 94 cases presented as mixed, and 21 cases presented as high-risk BCC (metatypical, morphea form). Mann-Whitney U test was used to compare recurrent BCC cases to non-recurrent cases. Significantly higher recurrence rates were observed if BCC at the time of the excision was ≥10 mm (p<0.001). Significance was also noted in cases where histopathology was mixed BCC and in cases where mixed BCC was localized to the nose region (p<0.001).. More attention should be brought to assessing classification and clinical treatment synergy. Higher recurrence rates are observed when lesions occur in high risk anatomical region (H zone), when lesion size reaches or exceeds 20 mm in diameter, and when lesion is subtyped as mixed BCC. It is crucial to evaluate risk factors such as BCC subtype and localization, as these are associated with a higher rate of recurrence when present in a single lesion. These risk factors, together with pre-treatment lesion evaluation will enable formulation of better treatment plan and prognostic aspects in each case.

Topics: Carcinoma, Basal Cell; Humans; Neoplasm Recurrence, Local; Nose; Retrospective Studies; Skin Neoplasms

Hemangioma is a benign tumor made up of blood vessels and typically occurs as a slightly elevated purplish or reddish area of skin. Hemangioma is mostly found superficially; subcutaneous hemangioma in the nasal dorsum is rare.. In West Nusa Tenggara Regional Hospital, the authors found two cases of subcutaneous hemangioma in patients of very different ages. The first patient was a 2-year-old Sasak girl, and the other was a 40-year-old Sasak man. The pediatric patient was treated with an elliptical approach, whereas the adult patient was treated with lateral rhinotomy extended by an elliptical approach to remove the hemangioma and ligate the feeding arteries. After surgery, the adult patient was followed up for 5 months, whereas the pediatric patient was followed up for 3 months. The results for both patients were good, with minimal scar formation.. Despite the limitations of technology and human resources in a remote area of Indonesia, the surgical approach used in these cases produced good outcomes for both patients.

Topics: Adult; Child; Child, Preschool; Cicatrix; Female; Hemangioma; Humans; Indonesia; Male; Nose; Skin Neoplasms

Reconstruction of the tip of the nose following the excision of skin cancer is a cosmetic and surgical challenge. We propose using a crescentic nasojugal flap, also known as a perialar crescentic advancement flap, to repair such defects. We present a series of 13 cases in which cutaneous carcinoma (mostly basal cell carcinoma) was excised from the lateral nasal tip with clear margins and the defect repaired with a crescentic nasojugal flap. The technique was successful in all cases. None of the patients developed notable surgical complications and the postoperative outcomes were satisfactory, with no significant functional or cosmetic problems. The crescentic nasojugal flap is therefore a good option for repairing medium-sized defects on the tip of the nose.

Topics: Carcinoma, Basal Cell; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Trichofolliculoma is an uncommon hair follicle hamartoma. It usually appears during adulthood on the face or scalp as a single, asymptomatic, skin-colored papule/nodule with small protruding hairs. Histopathological features are diagnostic. Very rare congenital cases have been reported. Herein, we report a congenital trichofolliculoma in a 15-year-old girl.

Topics: Adolescent; Female; Follicular Cyst; Humans; Neoplasms, Basal Cell; Nose; Skin; Skin Neoplasms

Malignant keratinocyte tumors-that is, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)-are commonly found on sun-exposed body areas such as the nose. The primary aim of tumor surgery is complete excision. Due to anatomical, functional, and aesthetic issues, reconstruction of such defects remains a challenge.. We report on a series of 52 patients that were treated from 2015 to 2019 at the Goldman Clinic in Porto Alegre, Brazil. The mean age was 63 years (range 28-82 years, standard deviation 14.25 years). Thirty-nine (75%) patients were male and 13 (25%) female. The histological diagnosis was BCC in 49 patients and SCC in three.. Nasal defect closures were located on the nasal dorsum, tip, alar nose, and nasion. The nasal dorsal and alar region were the regions most commonly involved. All tumor specimens were 3D histologically investigated. A nasolabial flap was the reconstructive option in 40 subjects (76.9%). A bilobed flap was used in six patients (11.5%). Other flaps used for defect closure were a Rintala flap (n = 2), tunneled island flap (n = 1), and frontal flap (n = 1). Adverse events were rare and manageable. Three relapses were noted during follow-up.. Nasal reconstruction requires an armamentarium of surgical techniques to tailor the procedures based on tumor localization, size, and depth, and patients' needs.

Topics: Adult; Aged; Aged, 80 and over; Brazil; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Aged; Aged, 80 and over; Esthetics; Female; Follow-Up Studies; Humans; Lip; Lip Neoplasms; Male; Nose; Nose Neoplasms; Patient Satisfaction; Postoperative Complications; Rhinoplasty; Severity of Illness Index; Skin Neoplasms; Surgical Flaps; Surgical Wound

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Skin; Skin Neoplasms; Surgical Flaps; Surgical Wound; Treatment Outcome

Accuracy of superficial radiotherapy for non-melanoma skin cancer is dependent on replicating the original clinical mark-up. Responses from 18 UK Radiotherapy centres identified the four most common replication techniques; the accuracy and time-efficiency of each was evaluated, as well as participant preference and confidence.. A 2.0  cm × 2.5  cm ellipse field was drawn around the nasal ala of a surrogate patient. Templates for each replication method (1-4) were created, and skin marks removed. Twenty-five therapeutic radiographers used each method to replicate the mark-up. Measurements were recorded for lateral and longitudinal displacement, ellipse diameter and time taken. A post-study questionnaire recorded participant preference and perceived confidence.. Comparison of the mean ellipse areas for methods 1-4 identified no statistically significant differences (ANOVA test; p = 0.579 to p = 0.999). Lateral and longitudinal displacements for method 1-4 showed a statistically significant difference between method 3 and each of methods 1, 2, 4 for lateral and longitudinal respectively (ANOVA; lateral: p = 0.008, p = 0.002, p = 0.05; longitudinal: p = 0.036, p = 0.000, and p = 0.000). Mean time taken was longest for method 3, and was compared using a Friedman test (p = 0.000) identifying a statistically significant difference. Twenty-two participants completed the questionnaire. 48% favoured method 2, 41% method 4. Method 3 was least favourite. A Likert scale (1-10) measured confidence. Participants had most confidence in methods 2 and 4.. In this study, method 3 was least accurate, most time consuming, and was least favoured by users. The clinical significance of these results will depend on the margins used in local practise.

Topics: Humans; Nose; Prospective Studies; Radiation Dosage; Radiation Protection; Skin Neoplasms; Surveys and Questionnaires

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Humans; Male; Nose; Patient Satisfaction; Postoperative Complications; Rhinoplasty; Skin; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Topics: Biopsy; Carcinoma, Basal Cell; Carcinoma, Merkel Cell; Humans; Male; Middle Aged; Mohs Surgery; Nose; Skin Neoplasms

The prognostic value of CD30 expression in cutaneous extranodal natural killer/T-cell lymphoma is controversial.. Clinicopathological features, survival outcomes, and prognostic implications of CD30 were retrospectively analyzed in 55 patients with cutaneous extranodal natural killer/T-cell lymphoma. We classified patients into (i) primary cutaneous extranodal natural killer/T-cell lymphoma and (ii) cutaneous extranodal natural killer/T-cell lymphoma secondary to nasal disease depending on the primary tumor site.. CD30+ cutaneous extranodal natural killer/T-cell lymphoma was more common in patients with cutaneous extranodal natural killer/T-cell lymphoma secondary to nasal disease than in those with primary cutaneous disease. CD30+ cases were more likely to present nodular lesions or cellulitis-like swelling than CD30- cases. Histologically, CD30+ cutaneous extranodal natural killer/T-cell lymphoma predominantly comprised large tumor cells compared with CD30- cases. However, the clinical morphology and tumor cell size were not associated with survival outcomes. CD30 expression was associated with better survival outcomes in patients with cutaneous extranodal natural killer/T-cell lymphoma secondary to nasal disease.. CD30+ cutaneous extranodal natural killer/T-cell lymphoma presented peculiar clinicopathological features and had more favorable disease course in patients with cutaneous dissemination from nasal disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Disease Progression; Female; Follow-Up Studies; Humans; Ki-1 Antigen; Lymphoma, Extranodal NK-T-Cell; Male; Middle Aged; Natural Killer T-Cells; Nose; Nose Neoplasms; Prognosis; Progression-Free Survival; Retrospective Studies; Skin; Skin Neoplasms; Young Adult

Basal cell carcinoma (BCC) occurs preferentially on the face. We retrospectively analyzed 200 cases of BCC treated at Nagoya City University Hospital from April 2004 to October 2015 and examined regional features based on modified facial aesthetic units. BCC occurred more frequently on the cheek, nasal and orbital areas. There was no significant difference between sides, and age was the only factor affecting tumor size.

Topics: Adult; Age Factors; Aged; Carcinoma, Basal Cell; Cheek; Face; Female; Humans; Japan; Male; Middle Aged; Nose; Orbit; Retrospective Studies; Skin Neoplasms

Mucosal melanoma is a rare malignant disease developed from melanocyte. We report the case of a patient with nasal cavity mucosal melanoma with a primary clinical and histological diagnosis of malignant lentigo with mucosal spreading. The presence of a c-Kit mutation, in a second lecture and the evolving nature of the lesion, reorientated the diagnosis of malignant lentigo to mucosal melanoma with skin extension. Extensive surgical resection and foramen free flap with costal graft reconstruction may have a local control of the disease. Yet, after one year, a regional evolution involving a parapharyngeal node was treated by stereotaxic radiotherapy. After 5 years, the patient was considered in clinical and radiological remission. Malignant lentigo with mucosal extension is a very rare situation, this diagnoses must be evoqued after setting mucosal melanoma diagnosis.

Topics: Aged; Diagnosis, Differential; Humans; Hutchinson's Melanotic Freckle; Male; Melanoma; Mutation; Nasal Cavity; Nasal Mucosa; Nose; Nose Neoplasms; Photography; Proto-Oncogene Proteins c-kit; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Topics: Aged; Biopsy, Needle; Carcinoma, Basal Cell; Cell Proliferation; Female; Follow-Up Studies; Humans; Immunohistochemistry; Mohs Surgery; Nose; Postoperative Care; Skin Neoplasms; Treatment Outcome

Topics: Aged; Asymptomatic Diseases; Biopsy; Bone Marrow; Female; Hand; Humans; Leukemia, Myelomonocytic, Chronic; Neoplasm Recurrence, Local; Nose; Recurrence; Skin; Skin Neoplasms

本研究对2015年1月至2018年1月，就诊于烟台芝罘医院、烟台毓璜顶医院、蓬莱市人民医院的外鼻肿瘤切除后较大皮肤缺损的7例患者选择双侧鼻唇沟联合皮瓣、鼻侧旋转皮瓣联合推进皮瓣进行一期修复，7例皮瓣全部成活，切口Ⅰ期愈合。随访8~36个月，术后皮瓣的肤色、血运、质地良好，切口瘢痕不明显，效果满意。对于鼻部较大皮肤缺损，视情况选择双侧鼻唇沟联合皮瓣或鼻侧旋转皮瓣联合推进皮瓣修复，可以达到理想的效果。.

Topics: Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Feline leishmaniasis (FeL) is an emerging infectious disease of cats caused by Leishmania infantum with global distribution. This study investigated the cause of chronic progressive cutaneous lesions in two cats from Central-west Brazil by using cytological, histopathologic, and immunohistochemical (IHC) analyses. Clinically, both cats had ulcerative cutaneous lesions at the nasal planum and ear resulting in a tentative diagnosis of squamous cell carcinoma (SCC). Moreover, both cats had varying degrees of onychogryphosis. However, cytology revealed chronic inflammatory reactions associated with intralesional amastigotes; histopathology confirmed chronic ulcerative dermatitis associated with intralesional and intracytoplasmic parasitic organisms consistent with amastigotes of Leishmania spp. within histiocytes. The IHC assay demonstrated that the intralesional parasitic structures identified by cytology and histopathology were immunoreactive to antigens of Leishmania spp., confirming the participation of this infectious disease agent in the development of the cutaneous lesions of these cats. The observation of onychogryphosis must be highlighted, since this lesion is frequently observed in dogs with visceral leishmaniasis but is underreported in FeL. Collectively, the pathologic and IHC findings of the chronic cutaneous disease confirmed active infections due to Leishmania spp. in these cats. Additionally, FeL with associated lesions to the ear and nasal planum must be considered as differential diagnosis for SCC in cats.

Topics: Animals; Biopsy, Fine-Needle; Brazil; Carcinoma, Squamous Cell; Cat Diseases; Cats; Cities; Diagnosis, Differential; Ear, External; Female; Forelimb; Hindlimb; Immunohistochemistry; Leishmania infantum; Leishmaniasis, Cutaneous; Nose; Skin Neoplasms

The nasolabial turnover flap was first described by Spear et al in 1987 for the coverage of full thickness defects of the lateral ala. It offered a single-stage repair that recreated the internal nasal lining, the external nasal valve, and the rounded contour of the ala without requiring a cartilage graft. A frequently encountered problem with the execution of Spear's original design is elevation of the ipsilateral commissure of the adjacent lip due to its broad proximal pedicle. Here, the authors describe a fusiform-type design with a proximal, superiorly tapered apex that relies on anteriorly coursing perforators from the underlying angular artery. The authors also review the inherent advantages and disadvantages of the flap itself and the unique situation where there is a skin cancer adjacent to the donor site.

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Merkel cell carcinoma (MCC) is a rare but more lethal cutaneous cancer than melanoma. However, spontaneous regression of a number of MCC has been reported, although the cause of this regression remains unclear. In most cases, MCC regresses after a surgical procedure, for example, biopsy. Herein, we report a case of Merkel cell polyomavirus-negative MCC coincident with squamous cell carcinoma (SCC) that underwent true spontaneous regression without biopsy. One month after the patient's first visit, clinical examination revealed that the tumor had not grown, but its surface showed changes in texture and color. Histopathologically, the excised specimen was indicative of MCC coincident with SCC and showed extensive necrosis in the upper portion of the tumor, numerous caspase-3-positive apoptotic cells, an accumulation of CD68-positive foam cells and vascular invasion. These findings suggested that the tumor had regressed. We hypothesize that extensive coagulative necrosis resulting from an insufficient local blood supply triggered the shedding of some products or components of MCC and SCC, which in turn induced antitumor immunity against both lesions.

Topics: Aged, 80 and over; Biopsy; Carcinoma, Merkel Cell; Carcinoma, Squamous Cell; Female; Humans; Margins of Excision; Merkel cell polyomavirus; Neoplasm Regression, Spontaneous; Neoplasms, Multiple Primary; Nose; Skin; Skin Neoplasms

Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result.. We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient.. A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred.. In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.

Topics: Adult; Aged; Aged, 80 and over; Blepharoplasty; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyelid Neoplasms; Female; Humans; Male; Melanoma; Middle Aged; Myocutaneous Flap; Nasal Cartilages; Nose; Plastic Surgery Procedures; Respiratory Mucosa; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Treatment Outcome; Young Adult

Topics: Carcinoma, Basal Cell; Face; Forehead; Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Squamoid eccrine ductal carcinoma (SEDC) is an extremely rare cutaneous tumor of unknown etiology. We report the case of a 77-year-old man with a history of treated chronic lymphocytic leukemia along with numerous basal cell and squamous cell carcinomas who presented for evaluation of a 5-cm, stellate, sclerotic plaque on the left chest of approximately 2 years' duration and a suspicious 3-mm pink papule on the right nasal sidewall of 2 months' duration. Initial histology of both lesions revealed carcinoma with squamous and ductal differentiation that extended from the undersurface of the epidermis, favoring a diagnosis of SEDC. It was later determined that the patient had distant metastasis of SEDC. This report of an immunocompromised patient with SEDC is a rare case of distant metastasis of SEDC. A review of the literature on the diagnosis, treatment, and surveillance of SEDC also is provided.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Neoplasm Metastasis; Neoplasms, Multiple Primary; Nose; Skin Neoplasms; Sweat Gland Neoplasms; Thorax

Fibrous papule (FP) is a common benign lesion located primarily in the nose. Although its histogenesis has been marred with controversies in the past, the dermal dendrocyte is now largely accepted to be the putative cell of origin. Histopathologic diagnosis of an FP is straightforward in most cases, which shows characteristics of an angiofibroma. Several histologic variants have been described, recognition of which is important to avoid a misdiagnosis and inappropriate treatment. This review presents a historical perspective into the histogenesis, discusses the histopathologic features and potential diagnostic pitfalls of classic FP, and lists the various histologic variants and their differential diagnoses.

Topics: Angiofibroma; Humans; Nose; Skin Neoplasms

Skin cancer removal surgery involving the tip or dorsum of the nose often results in large-sized defects with exposure of cartilage. In such cases, the paramedian forehead flap is a frequently used reconstruction technique; however, this method is complex and can result in a cosmetically unsatisfying outcome.. To describe the folded transposition flap as an aesthetically pleasing alternative to the paramedian forehead flap for large nasal defects with exposed cartilage.. The folded transposition flap is a 2-stage surgical modification of the transposition flap. In the first stage, an overlong axial cheek pedicle is used to cover the defect. In the second stage, the flap is thinned and the nasal scars are revised.. All 4 patients experienced aesthetically pleasing results.. The folded transposition flap is an alternative for reconstructing large surgical defects of the nasal tip or distal dorsum of the nose.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Dermatologic Surgical Procedures; Esthetics; Female; Forehead; Humans; Male; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Wounds and Injuries; Xanthomatosis

Topics: Anesthesia, Local; Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Suture Techniques; Sutures

Cosmetic consultations are routinely part of a dermatologist’s day. Often, patients present after consultation from another dermatologist or other physician with an established diagnosis and would like a particular treatment to resolve their condition. However, it is imperative to take a full history and physical exam prior to rendering treatment in the event of a missed or new diagnosis.

Topics: Biopsy; Cosmetic Techniques; Hemangiosarcoma; Humans; Lasers; Male; Middle Aged; Nasal Surgical Procedures; Nose; Radiotherapy, Adjuvant; Skin Neoplasms

Topics: Biopsy; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Diagnosis, Differential; Humans; Male; Nose; Skin Neoplasms

Cutaneous T-cell post-transplant lymphoproliferative disorder (PTLD) is a rare clinical presentation that can potentially turn aggressive in solid-organ transplant recipients if not detected and intervened on early. We encountered a rare case of rapidly worsening primary cutaneous CD30-positive, Epstein-Barr virus-negative anaplastic large cell lymphoma (ALCL) of T-cell origin, manifesting as an isolated nasal tip lesion in a 71-year-old man 4 years after orthotopic liver transplantation. Excisional biopsy with partial rhinectomy showed subepithelial diffuse infiltration of medium-to-large lymphoid cells having round-to-irregular nuclei, partially condensed chromatin and prominent nucleoli. Immunophenotypic studies revealed CD30-positive primary cutaneous ALCL. Positron emission tomography/CT imaging revealed a locally active disease, and radiation therapy was initiated with complete response. A high index of suspicion for PTLD when evaluating skin lesions in a post-transplant patient is paramount for its early recognition, prompt diagnosis and timely intervention while the window for curative therapy remains possible.

Topics: Aged; Biopsy; Diagnosis, Differential; Humans; Liver Transplantation; Lymphoma, T-Cell, Cutaneous; Male; Nose; Positron-Emission Tomography; Skin Neoplasms; Tomography, X-Ray Computed

Topics: Carcinoma, Basal Cell; Forehead; Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

A higher incidence of lentigo maligna (LM) recurrences on the nose was previously observed in our cohort after non-surgical treatment.. To determine histological parameters that might be related to the previously observed higher incidence of LM recurrences on the nose after non-surgical treatment.. We randomly selected 22 surgical specimens of LM on the nose and 22 on the cheek. Histopathological analysis was performed on haematoxylin and eosin stained and microphthalmia transcription factor immunohistochemically stained slides. The number of pilosebaceous units (PSU) per mm, maximum depth of atypical melanocytes along the skin appendages and maximum depth of the PSU itself were determined.. The nose had a significantly higher density of PSU than the cheek. The atypical melanocytes extended deeper along the PSU on the nose with a mean (SD) depth of 1.29 mm (0.48) vs. a mean depth of 0.72 mm (0.30) on the cheek (P < 0.001). The maximum depth of the PSU on the nose was greater than on the cheek, mean (SD) depth of 2.28 mm (0.41) vs. 1.65 mm (0.82) (P = 0.003).. The higher recurrence risk of LM on the nose after non-surgical treatment that we previously observed in our cohort is most likely based on a higher density of atypical melanocytes and also their deeper extension into the follicles. These results shed more light on our previous findings and learn that anatomical location is relevant for the risk of recurrence of LM after non-surgical treatment.

Topics: Aged; Aged, 80 and over; Cheek; Female; Hair Follicle; Humans; Hutchinson's Melanotic Freckle; Male; Melanocytes; Microphthalmia-Associated Transcription Factor; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Risk Factors; Sebaceous Glands; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Ear Cartilage; Female; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Tumor extirpation of nonmelanoma skin cancer (NMSC) adjacent to the alar groove, using Mohs micrographic surgery (MMS), may risk causing internal nasal valve (INV) collapse, resulting in reduced airflow during inspiration. There are many surgical options described in the literature to repair INV collapse as a postoperative corrective procedure, but few exist as an intra-operative preventative procedure.. The authors present 2 distinct methods to prevent and treat INV collapse during the repair of a perialar surgical defect caused by MMS.. A 3-point stitch method or a modified suspension suture technique was used to prevent INV collapse during the repair of MMS defects overlying the alar groove, for nonmelanoma skin cancers. The 3-point stitch was used with a complex repair. The modified suspension suture was used with flap reconstruction.. The 3-point stitch and the modified suspension suture are simple, single-stage surgical solutions for perialar defects with collapse of the INV caused by loss of subcutaneous tissue during MMS. Once executed, patients experienced immediate subjective airflow improvement which was also supported by clinical examination. Patients were followed at 1 week and at 3 months postoperatively. Thirty-four of 35 patients reported good functional and cosmetic results and were satisfied with the final outcome.. The 3-point stitch and the modified suspension suture techniques are easy and simple methods that can be incorporated into reconstruction after MMS for defects of variable depth covering any multisubunit perialar region to prevent or correct INV collapse.

Topics: Follow-Up Studies; Humans; Mohs Surgery; Nasal Obstruction; Nose; Nose Neoplasms; Patient Satisfaction; Postoperative Period; Retrospective Studies; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Suture Techniques; Treatment Outcome

Intramuscular lipomas are rare, benign, mesenchymal tumors occurring deep in the fascia, typically involving large muscle groups in adults. We report a case of an intramuscular lipoma occurring as a subcutaneous midline nasal mass in a 3-month-old infant. The differential diagnosis of a midline mass on the glabella of an infant is important and should include developmental anomalies such as nasal glioma, nasal dermoid cyst, and encephalocele, so neuroimaging is an essential first step in evaluating these lesions to exclude intracranial extension.

Topics: Biopsy, Needle; Dermoid Cyst; Diagnosis, Differential; Encephalocele; Follow-Up Studies; Glioma; Humans; Immunohistochemistry; Infant; Lipoma; Male; Neuroimaging; Nose; Risk Assessment; Skin Neoplasms; Subcutaneous Tissue; Tomography, X-Ray Computed; Treatment Outcome

Vismodegib is an oral inhibitor of the Hedgehog signaling pathway and has been used to treat basal cell carcinoma (BCC) in adults. This article reports clearance of a nodular BCC of the nasal tip in an 8-year-old boy with xeroderma pigmentosum (XP). BCC can pose therapeutic challenges when located in areas that are not amenable to traditional therapies such as Mohs micrographic surgery or topical agents. Vismodegib was used at a dose of 150 mg/day to treat the boy's BCC. After 4 months of therapy, we achieved complete clinical clearance. During 21 months of follow-up, the patient's nose remained clinically clear of tumor. Vismodegib was successfully used to treat a child with XP and nodular BCC. Our goal in using vismodegib was tumor regression while avoiding cosmetic and functional disfigurement. Vismodegib was effective in clinically clearing the tumor, and the patient has shown no signs of recurrence. Further studies are warranted.

Topics: Anilides; Carcinoma, Basal Cell; Child; Facial Neoplasms; Humans; Male; Nose; Pyridines; Skin Neoplasms; Xeroderma Pigmentosum

To evaluate the effect of nasolabial flap with Facial artery perforator for repairing defects after resection of midface tumor.. Between January 2012 and June 2015,31 cases with midface tumor, including base cell carcinoma(18 cases),squamous cell carcinoma(13 cases).The tumor size ranged from 0.8 cm × 2.0 cm to 2.0 cm × 3.5 cm. The extended resection of the tumor tissue was performed according to the characters of tumor. Intraoperative frozen specimen was used to make sure no invasion at margin and wound base. According to the location and size of the defect, nasolabial flap with perforator was designed to repair the defect, the defect at donor site was directly closed. The flaps size ranged from 1.5 cm × 3.0 cm to 3.0 cm × 5.0 cm, and the pedicle length was 1.0 cm to 2.5 cm.. All the 31 flaps survived completely, including 5 cases with vascular crisis at the flap tip, which resolved after active procedure. All the patients were followed up for 6-36 months with unconspicious scar at nasolabial fold and no deformities. The flap had satisfactory appearance with good match of texture and color.. Nasolabial flap with facial artery perforator is an optimal choice for reconstruction of facial defects with good appearance and flexible transfer.

Topics: Arteries; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cicatrix; Face; Head; Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Topics: Biopsy, Needle; Disease Progression; Drug Therapy, Combination; Etoposide; Fatal Outcome; Female; Humans; Immunohistochemistry; Langerhans Cell Sarcoma; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Nose; Positron-Emission Tomography; Prednisone; Rare Diseases; Risk Assessment; Skin Neoplasms; Vincristine

Topics: Facial Neoplasms; Female; Humans; Lip; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Facial Neoplasms; Female; Humans; Lip; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Aged; Carcinoma, Basal Cell; Cartilage; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Wound Healing

Single-stage repairs of large nasal dorsum defects risk introducing lower nasal distortion.. To describe the authors experience with the "birhombic" flap, a bilateral Dufourmentel rhomboid flap, for repair of nasal surgical defects after Mohs micrographic surgery.. The authors performed a retrospective chart review of patients who underwent birhombic flap repair of the nose by a single physician after Mohs micrographic surgery from 2008 to 2013 at the Medical University of South Carolina.. Thirty-eight patients were identified on whom the birhombic flap repair was performed on the nasal dorsum over a 6-year period. There were no significant complications. Alar position remained neutral and nasal profile remained unaltered in all cases. Postoperatively, pulsed dye laser was performed in 8 patients (21%) and dermabrasion in 11 patients (29%). All patients achieved very good or excellent final aesthetic results.. The birhombic flap is a reproducible, one-stage flap for small to large defects of the nasal dorsum that consistently produces topographic restoration with minimal risk of aesthetic or functional complication. The use of 2 opposing flaps redistributes the secondary defect, thus minimizing the potential for lower nasal distortion when closing the flaps' donor sites.

Topics: Aged; Aged, 80 and over; Dermabrasion; Esthetics; Female; Humans; Lasers, Dye; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Retrospective Studies; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Non-melanoma skin cancers are the most frequent skin tumours; in 25.5% of cases, they are reported to affect the nasal area. For an excellent surgical outcome, first of all the radical excision of the lesion is important, with appropriate margins of healthy skin in order to avoid recurrences. Moreover is important to achieve a good aesthetical result, avoiding distortion of the aesthetic units and preserving their functions.. We have applied the modified crescentic flap, described by Smadja in 2007, to 24 nasal skin defects left by oncologic surgery. It consists of the crescent-shaped resection of Burow's triangle all around the alar groove that allows the advancement of the flap to the tip of the nose, hiding the scar in the alar groove.. The outcome and the long-term follow-up were completely satisfactory both for patients and for surgeons.. For skin defects localized in the midline or paramedian line of the dorsum of the nose, the crescentic flap seems to be a good solution to obtain the better aesthetic result with respect to both anatomy and function of the nasal area, sparing the patient a second intervention or an overly invasive procedure.

Topics: Aged; Esthetics; Female; Humans; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Aged; Bone Neoplasms; Cell Differentiation; Chondrosarcoma; Humans; Immunohistochemistry; Male; Nose; Osteosarcoma; Skin; Skin Neoplasms

The quadrilobe flap allows the mobilisation of the skin of the upper nose and nasofacial sulcus to the distal nose while avoiding unfavourable tension vectors that would distort the free margin of the ala. We report our experience over the past 3 years in the first case series of quadrilobe flaps for repair of surgical defects on the nose.

Topics: Carcinoma, Basal Cell; Cohort Studies; Esthetics; Female; Graft Survival; Humans; Male; Mohs Surgery; Nose; Retrospective Studies; Risk Assessment; Skin Neoplasms; Surgical Flaps; Wound Healing

Reconstruction of the nasal tip defects is challenging because of variable contours of the region and the unique texture, thickness, color, and limited amount of available skin. There are several well-known local flaps for this purpose. Unfortunately, most of these flaps are suitable for small sized defects up to 2 cm in diameter. In this study, the authors are presenting a new flap for reconstruction of nasal tip and supratip defects larger than 2 cm in diameter.. Pincer flap was used for reconstruction of nasal tip defects in 12 patients, between 2011 and 2014. The mean age was 67 (43-88). All patients had a basal cell carcinoma. Defects were located at the central nasal, lateral nasal, and supratip areas. All tumors were excised with safe margins. After the excision, defects were reconstructed with pincer flap in the same session.. The mean follow-up period was 11 (6-18) months. There was not any flap loss. Infection and venous congestion was observed in 2 patients but the patient did not require any further surgical intervention, and healed with local and systemic antibiotherapy. No recurrence occurred and the outcome was aesthetically favorable.. The authors concluded that pincer flap is reliable and may provide a single-stage reconstruction for the nasal tip defects larger than 2 cm and up to 3 cm in diameter.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Hyperemia; Male; Margins of Excision; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Postoperative Complications; Rhinoplasty; Skin Neoplasms; Skin Pigmentation; Surgical Flaps

Conventionally, articles dealing with nasal defects plan reconstructions regarding the aesthetic subunits, imposing their systematic respect. We propose to study the reconstruction of a crossroad region of three subunits, tip, alar lobule and lateral sidewall, where that full compliance is not possible, in our experience of 36 patients.. Our retrospective study from January 2011 to December 2012 focused on patients with a defect in this crossroad region that was repaired by skin graft or flap. We described the population of the study, histological type of the lesions, surgical procedures and complications. We evaluated the reconstructions performed with a photographic review 1 year post-surgery according to the criteria of symmetry, discoloration, thickness, shrinkage, and rating on the Vancouver Scar Scale, which helped create an overall aesthetic score for the reconstruction.. Of 144 patients with a nasal defect, 36 of them (25%) were included, presenting a defect in our study area. The reconstruction was made by eight hatchet flaps, eight frontal flaps, seven bilobed flaps, five advanced-rotated lateronasal flaps, four nasolabial flaps, two Rybka flaps and two total skin grafts. The advanced-rotated flap, hatchet flap and bilobed flap had the highest results and scores, according to the criteria assessed. Rybka flap and total skin grafts had the lowest results.. The occurrence of a defect in the crossroads seems common. In this indication, specific local flaps had a favourable outcome, including review of the overall esthetic score which was created to standardize the assessment of reconstructions.

Topics: Aged; Aged, 80 and over; Carcinoma; Esthetics; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Retrospective Studies; Skin Neoplasms; Surgical Flaps

Topics: Adult; Fatal Outcome; Female; Hand; Humans; Kidney Transplantation; Lung Neoplasms; Lymphoma, Extranodal NK-T-Cell; Magnetic Resonance Imaging; Nose; Nose Neoplasms; Skin Neoplasms

Composite nasal defects require skin, framework, and lining reconstruction. The forehead flap is an ideal donor for skin coverage because of good color match and excellent donor-site healing. Intranasal flaps and grafts are reserved for lining reconstruction of small defects. Locoregional and free flaps are used for larger lining defects, but these may not be ideal or safe. The authors advocate the double forehead flap for large composite defects of the nose in a subset of patients.. Three men and three women aged 55-87 years (average 74.7 years) were treated for composite nasal defects that resulted from cancer (n = 5) and trauma (n = 1). Skin and lining defects were >2 cm in every dimension. Double forehead flaps were raised in stages (n = 1) or simultaneously (n = 5), and nasal reconstruction was performed in two (n = 1) or three stages (n = 5).. Patients were followed for 19.3 months (range 13-24 months). Donor sites of flaps raised in stages healed after 3 months. When flaps were raised together, healing required 5-13 months (average 7.6 months). There were no partial or complete flap losses. None of the patients had infection, hematoma, or nerve injury. Satisfactory aesthetic results were achieved in every case.. The authors advocate the double forehead flap for large composite nasal defects in patients who are not suitable candidates for nasolabial flaps and those who may not tolerate free tissue transfer. The advantages of this method must be weighed against the drawbacks, which include prolonged donor-site healing and elimination of the contralateral forehead flap.

Topics: Aged; Aged, 80 and over; Female; Forehead; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Surgical Flaps

This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center.. A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05.. A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates.. Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.

Topics: Age Factors; Aged; Aged, 80 and over; Anesthesia; Carcinoma, Basal Cell; Facial Neoplasms; Female; Forehead; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Nose; Retrospective Studies; Risk Factors; Skin Neoplasms; Surgical Flaps; Time Factors; Tumor Burden

This article evaluates malignant transformation of lesions presenting in the periocular skin under the eye spectacle nose pad. A non-comparative retrospective chart review of clinical features and pathological findings of patients presenting with periocular malignancies in the exact vicinity where the nose pads of their eye spectacles rested was completed. The study took place in one tertiary oculoplastic referral center between 2007-2013. Ten patients were included, six of whom were male. All subjects wore eye spectacles while awake for at least 15 years, and had an evident suspicious lesion in the exact area that coincided with the resting place of the nose pad. The mean age was 73.5 years (range 65-85 years) and all patients had the lesion present for at least one year. Most cases were squamous skin malignancies (five squamous cell carcinomas [SCC], 2 intra-epidermal carcinomas [IEC], while 3 basal cell carcinomas [BCC]). Treatment involved surgical excision of the lesion with frozen section for margin control and reconstruction with a myocutaneous flap. Periocular malignancies of the inferior medial canthal area, where the nose pad of eye spectacle places pressure, can be easily missed or misdiagnosed. Marjolin ulcers (MU) classically present as an aggressive SCC in area of chronic inflammation, which has been previously correlated to constant pressure, repetitive trauma, or non-healing wounds in other areas of the body. We propose that the traumatic chronic pressure in the infero-medial canthal region from long-term eye spectacle nose pad use, may induce poor lymphatic regeneration leading to an immune system deficiency that predisposes this skin to a malignant transformation. The presence of chronic eye spectacle nose pads also prevents proper and timely detection of such malignancies. Complete excision of these lesions with margin control, adequate follow-up for possible recurrence, and surveillance for new lesions on the patient's contralateral side, is crucial for adequate management.

Topics: Aged; Aged, 80 and over; Carcinoma in Situ; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Eyeglasses; Female; Humans; Male; Nose; Retrospective Studies; Skin Neoplasms

Microcystic adnexal carcinoma (MAC) is a rare malignant cutaneous adenocarcinoma that typically occurs in the head and neck, particularly at the central face. There are only slightly more than 300 patients reported worldwide, and most patients occur in Caucasians. A 72-year-old man was referred to our hospital for definitive treatment of known MAC from previous biopsy. Wide excision of nasal tip and reconstruction of nasal defect with paramedian forehead flap and nasolabial flap transposition were performed rather than conventional Mohs surgery, due to grossly evident disease. Pathological examination verified 4.5 × 3 cm sized MAC with free resection margins. The patient is being followed up without any evidence of disease.

Topics: Aged; Forehead; Humans; Male; Mohs Surgery; Nose; Skin; Skin Neoplasms; Surgical Flaps; Sweat Gland Neoplasms

The glabella is an aesthetic subunit placed on the forehead between the eyebrows. The reconstruction of this area can be challenging for cosmetic outcomes. In our experience, moderate glabellar defects reconstruction should introduce extra skin to preserve the interciliary space.. Under local anesthesia, tumoral excision with safety margins on the glabellar area was performed in 5 patients. The oncologic resection resulted in moderate sized glabellar defects. We used a myocutaneous nasal root island flap based on the periocular muscles for the reconstruction of these defects with primary closure of the donor site.. Five nasal root island flaps were successfully performed for glabellar defects reconstruction after tumoral excisions. The aesthetic results were satisfactory with respect to color and texture match and scars qualities. The eyebrow junction was successfully avoided.. We present an alternative method for the reconstruction of central and moderate sized glabellar defects. The nasal root island flap is a reliable and easy to perform 1-stage technique with satisfactory aesthetic outcomes.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Head and Neck Neoplasms; Humans; Hutchinson's Melanotic Freckle; Male; Middle Aged; Myocutaneous Flap; Nose; Plastic Surgery Procedures; Pseudolymphoma; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome

Nasolabial flaps based on the lateral side of the nose for the reconstruction of lateral nasal defects in a single-stage procedure have been described. Similarly, in midline defects, nasolabial flaps can be used but a 2-stage procedure is classically required. The Midline-based Nasolabial Transposition (MNT) flap is presented as a new single-stage procedure for nasal tip reconstruction.. Between 2009 and 2011, an MNT flap was used as a single-stage procedure in 3 cases of large nasal defects of the tip where the forehead flap was either contraindicated or rejected as an option by the patient.. There were no complications and a satisfactory aesthetic result was achieved in all cases.. The MNT flap is a new single-stage procedure for large nasal tip defects and as such represents an interesting alternative to the classical 2-stage forehead and nasolabial flaps, especially in elderly patients.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Lip; Male; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck; Surgical Flaps; Treatment Outcome

Angular artery, lateral nasal artery, and infraorbital artery pedicled nasolabial flaps have been used for reconstruction of lower nose and medial cheek defects. An alternative pedicle to raise a flap in the nasolabial area is the superior labial artery. Superior labial artery is a constant branch of the facial artery, arising above or at the angle of mouth and anastomoses with its counterpart in the middle of the upper lip. This makes a reverse superior labial artery pedicle possible for elevation of a nasolabial flap.. Reverse superior labial artery island flaps were used for reconstruction of lower nose and medial cheek defects in 12 patients. Eleven patients presented with malignant skin lesions and 1 with a traumatic defect of the lower nose. Auricular cartilage graft to support the alar rim and nasal tip was combined to the flap in 3 patients.. All flaps survived completely. Temporary venous congestion was observed in 3 flaps in the early postoperative period but this resolved in 3 to 5 days. All patients healed without any postoperative complications and the final results were considered satisfactory.. Reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery-based nasolabial flaps where these arteries could also be used as pedicle.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Ear Cartilage; Facial Neoplasms; Female; Humans; Lip; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Forehead; Histological Techniques; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Postoperative Complications; Skin Neoplasms; Surgical Flaps; Treatment Outcome; Wound Healing

Topics: Anilides; Biopsy, Needle; Carcinoma, Basal Cell; Epidermal Cyst; Face; Follow-Up Studies; Humans; Immunohistochemistry; Keratosis; Male; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Nose; Pyridines; Risk Assessment; Skin Neoplasms; Treatment Outcome

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Male; Nose; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Suture Techniques; Treatment Outcome

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Nasal Cartilages; Nose; Patient Satisfaction; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Topics: Ataxia; Brain Neoplasms; Humans; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Nose; Recurrence; Skin Neoplasms

Topics: Catheters; Humans; Nasal Surgical Procedures; Nose; Oxygen; Plastic Surgery Procedures; Postoperative Hemorrhage; Skin Neoplasms

Titanium mesh has been employed in neurosurgery, plastic surgery, and maxillofacial surgery as a bone replacement in diverse conditions. We first reported on its use as a substitute for osteocartilaginous nasal structure with satisfactory functional and aesthetic results in 2009.. To assess the utility and tolerance of titanium mesh as a substitute of the osteocartilaginous portion of the nose.. Eleven patients were identified who had a nasal reconstruction with titanium mesh. We retrospectively searched for infection, extrusion, nasal valve collapse, second surgery, and patient satisfaction in the patients' records. All patients presented with various types of non-melanoma skin cancer in the nasal pyramid. In the reconstruction of full-thickness nasal defects, local flaps were used, employing titanium mesh as a support structure.. No mesh extrusions, infections, or collapse of the nasal valve were noted in patients with a mean follow-up of five years. Only one patient needed a second surgery to debulk the flap. Patient satisfaction achieved a mean score of 7.5 out of 9 in 10 patients.. As cartilage grafts need a second surgical site, with consequent morbidity, the use of titanium mesh proves useful and safe in the reconstruction of nasal full-thickness defects. The results of our series of patients demonstrate the suitability of this material in the repair of nasal osteochondral defects, as well as its low rate of complications.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermatologic Surgical Procedures; Female; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Patient Satisfaction; Prostheses and Implants; Reoperation; Retrospective Studies; Skin Neoplasms; Surgical Flaps; Surgical Mesh; Titanium

The area of the nose immediately medial to the nasofacial groove is a common site for relatively small but penetrating basal cell carcinomas (BCCs). Although larger lesions may necessitate formal subunit reconstruction, smaller lesions pose a considerable dilemma. Full-thickness skin grafts (FTSGs) often result in an unsightly contour defect. Local flap options exist, but they frequently violate subunit boundaries or anatomical landmarks. In particular, the single-stage nasolabial transposition flap is particularly prone to blunting of the nasofacial angle and fullness or pin-cushioning of the flap with concomitant loss of facial symmetry.. We present a consecutive case series of 21 patients with lesions at this site who underwent reconstruction with a combination of a subcutaneous flap from the adjacent cheek fat, which is then resurfaced with an overlying FTSG.. A range of defects of dimensions up to 17 mm diameter were included in the series. There were no instances of haematoma, post-operative infection or graft failure. A single patient, who smoked 30 cigarettes daily, underwent a complex reconstruction combining a cartilage graft with a fat flap and a skin graft. He experienced some epidermal loss that healed without intervention, with a remarkable outcome. The results show this to be a reliable and reproducible method that delivers excellent restoration of the contour without disrupting the symmetry of the nasofacial sulcus.. Augmenting a skin graft with a subcutaneous fat transposition flap is a simple technique that is quick to learn and straightforward to execute. Excellent outcomes were consistently obtained without the asymmetry and pin-cushioning often associated with local flaps at this site.

Topics: Carcinoma, Basal Cell; Decision Making; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Subcutaneous Tissue; Surgical Flaps

Topics: Angiofibroma; Child; Humans; Male; Nose; Skin; Skin Neoplasms

This case series explores the use of vismodegib to treat locally advanced basal cell carcinoma (laBCC), with a focus on tolerability, efficacy, and outcomes after treatment cessation.. Data from patients who underwent vismodegib treatment for laBCC at a single institution from 3/6/2012 through 3/15/2015 was utilized in this study. For all included cases, treatment responses as recorded at the first follow-up after treatment cessation were assessed and are reported as complete clinical response (CCR), partial clinical response (PCR), stable disease, or progressive disease. In cases of CCR, clinical disease free survival (DFS) was calculated as the time from cessation of vismodegib until last available follow-up, death, or recurrence. Data pertaining to side effects and adverse events was also recorded, and results are presented using descriptive statistics.. A total of 24 patients and 31 tumors met inclusion criteria. CCR was observed in 17 of 31 tumors (55%), and 13 of 31 tumors (42%) demonstrated PCR. Stable disease was seen in one patient (one tumor) (3%). No cases demonstrated clinical tumor progression during treatment. The mean clinical DFS at time of data cut off for all cases of CCR was 9.3 months (range 2-21 months). In cases of PCR, the mean reduction in tumor size was 52% (range, 11%-80%). Only two patients (8%) discontinued treatment secondary to side effects.. Each patient and each tumor responds uniquely to vismodegib treatment, including variable tumor responses and a wide range of side effects and tolerability. This study highlights important unique observations, and our data as a whole adds to previously published studies, leading to thought provoking questions. Overall, the FDA approval of vismodegib for advanced basal cell carcinoma has markedly improved the prognosis and care of affected patients.

Topics: Adult; Aged; Aged, 80 and over; Anilides; Antineoplastic Agents; Carcinoma, Basal Cell; Cheek; Disease Progression; Disease-Free Survival; Facial Neoplasms; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Nose; Pyridines; Scalp; Skin Neoplasms; Thorax; Treatment Outcome; Tumor Burden

The repair of full-thickness nasal alar defects presents difficulties because of their complex 3-dimensional structure. Reconstructions using inappropriate methods may lead to asymmetries and dissatisfying functional results. In this study, our aim was to present the repairs of full-thickness alar defects performed using cartilage-supported nasolabial perforator flaps.. Eight patients who presented to our clinic between January 2011 and April 2014 with full-thickness defects in the alar wings were included in this study. The nasolabial perforator flap was prepared on the basis of the closest perforator to the defect area and in a way to include 2 to 3 mm of subcutaneous adipose tissue. The medial section of the flap was adapted to form the nasal lining. In the 7 patients in whom cartilage support was used, the cartilage graft was obtained from the septum nasi. After the cartilage was placed on the flap, the lateral section of the flap was folded over the medial section and the defect was repaired. In 1 patient in whom cartilage support was not required, the flap was folded over itself before the repair was performed. The flap donor area was primarily repaired.. No detachment around the suture lines, infection, venous insufficiency in the flap, or partial or total flap losses were observed in any of the patients. Retraction developed in 1 patient in whom no cartilage support was used. No retraction was observed in any of the patients in whom cartilage support was used. The results were functionally and esthetically satisfying in all the patients.. The greatest advantage of perforator-based nasolabial flaps is the greater mobilization achieved in comparison with the other nasolabial flaps. Thus, full-thickness defects can be repaired in 1 session in some patients, no revision is required around the flap pedicle, and much less donor area morbidity occurs. Nasal alar reconstructions performed using this type of flap lead to both esthetically and functionally satisfying results.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Lip; Male; Middle Aged; Nasal Cartilages; Nose; Nose Neoplasms; Perforator Flap; Rhinoplasty; Skin Neoplasms; Treatment Outcome

To explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.. (1) 10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system, MIMICS). The origin and distribution of the angular artery perforator were observed. (2) Between July 2012 and July 2014, twenty-one patients underwent operations for the reconstruction of midface defect. Ten patients had squamous cell carcinoma, nine patients had basal cell carcinoma and two patients had nevus. The flaps' size ranged from 1.5 cm x 3.5 cm to 2.5 cm x 5.0 cm.. The facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth, subsequently strenches to inner canthus continuing as the angular artery. The angular artery anastomoses extensively with the dorsal nasal artery and the infraorbital artery. All the flaps survived. The patients were satisfied with the final aesthetic and functional results.. The flap can be designed flexibly and simply with reliable blood supply. The donor sites could be closed directly without skin graft, it is a simple and fast method for the reconstruction of midface defect.

Topics: Anastomosis, Surgical; Arteries; Cadaver; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Face; Facial Neoplasms; Humans; Nevus; Nose; Perforator Flap; Skin Neoplasms; Skin Transplantation; Software; Tomography, Spiral Computed

The nasal region represents an important three-dimensional esthetic unit where minimal distortion will be obvious and disturbing. In this regard the reconstruction of the nasal ala in dermatologic tumor surgery may be challenging. We propose the reconstructive option of a caudal-lateral inserted transposition flap for this indication. The principle of this surgical alternative and the long-term outcome is demonstrated in representative cases. The various indications and modifications of this reconstructive principle are discussed and compared to other remodeling alternatives.

Topics: Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Pseudoaneurysm is a well-known complication of trauma and iatrogenic injury to the vasculature. We report 3 cases of postsurgical pseudoaneurysm after Mohs surgery.. Three patients who underwent Mohs surgery for nonmelanoma skin cancers presented between 2 and 4 weeks after surgery with several days' history of painful, enlarging, pulsatile subcutaneous masses. The lesions were diagnosed as postsurgical pseudoaneurysm. During surgical repair of each lesion, we identified vascular outpouchings that were connected to the injured arteries by sinus tracts. In all 3 patients, we ligated the affected artery and the neck of each lesion and reapproximated the skin. All wounds healed well without further recurrence.. Most reported cases of pseudoaneurysm formation in the head and neck involve the superficial temporal artery and its branches, and they typically occur secondary to blunt force trauma. Our cases are unique in that they included 1 case of a superficial temporal lesion but also 2 cases outside this system: 1 of the lateral nasal artery and 1 of the angular artery. We propose operative repair as the treatment of choice for facial pseudoaneurysms that complicate dermatologic surgery.

Topics: Aged; Aged, 80 and over; Aneurysm, False; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Iatrogenic Disease; Male; Middle Aged; Mohs Surgery; Nose; Postoperative Complications; Risk Assessment; Sampling Studies; Skin Neoplasms; Treatment Outcome; Vascular Surgical Procedures

The importance of the paranasal and periorbital regions on the aesthetics of the face presents a variety of reconstructive challenges for surgical and traumatic defects of those regions. We used the cranially based nasolabial flap in patients with full-thickness soft-tissue defects of the paranasal and periorbital regions harvested from the contralateral side of the present defect. We present our experience in 25 patients of geriatric population (13 females and 12 males with a mean age of 76) with complex soft-tissue defects in the paranasal and periorbital regions whose defects were reconstructed with contralateral nasolabial skin flaps. Sizes of the defects changed between 2 × 3 cm and 6 × 7 cm. The flap sizes varied from a width of 2 to 5 cm (average 3 cm) and a length of 7 to 11 cm (average 8 cm). Primary closure of the donor sites of the flaps was possible in 24 of the patients in this series. Twenty-one flaps of this series (84%) healed without any necrosis and completely survived. The contralateral nasolabial flap is a very convenient, safe and reliable flap that can be used in medium to large paranasal and periorbital defects. Optimal aesthetic results for a variety of central facial defects could be obtained with this flap, especially when the ipsilateral nasolabial flap cannot be used due to various reasons.

Topics: Aged; Aged, 80 and over; Eye; Face; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Defects of the nasal dorsum have historically been repaired based on size and with respect to subunit principle. This case series provides a previously undescribed option for correcting defects of the nasal dorsum 1.5-2.5 cm in size. The foremost advantages of this technique are preservation of nasal subunit integrity and the integration of subtle nasal tip rotation.. We present a case series involving five consecutive patients aged 49-74 after Mohs excision for malignancies of the nasal dorsum. Defects were corrected using the aesthetic modification to the Rintala flap over a 10-year period by two primary surgeons.. The aesthetic modification to the Rintala flap should be considered as a reconstruction option for patients with defects of the nasal dorsum between 1.5 and 2.5 cm in size, especially for those patients desiring rotation of the nasal tip.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Aged; Carcinoma, Basal Cell; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mohs Surgery; Nose; Retrospective Studies; Sampling Studies; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Treatment Outcome; Wound Healing

The upper nasolabial flap was initially described by Kilner in 1937, and popularized by Préaux in 1994. It is an interesting solution for the reconstruction of the ala thanks to its simplicity and reliability. Nevertheless, the results obtained with the original technique could be improved because of scars on the side of the nose and the absence of nostril groove. That is why we propose a modification of the surgical technique. We present the case of an 82-year-old female patient who presented with a basal cell carcinoma of the right nasal wing rebuilt by a modified upper nasolabial flap. The skin triangle above the defect, which separated it from the flap pedicle, was not sacrificed but dissected forward from behind, to the junction between the nasal dorsum and the lateral side of the nose. The next step, key step of our technique, was removing the epidermis from the flap pedicle. The nasolabial flap was thus slid forward to the alar loss of substance, thereby recreating a nostril groove nose with a single scar. The scar was thus more discrete than with the conventional technique. The other steps did not differ from the conventional technique. The immediate postoperative course was uneventful. Rebuilding a loss of transfixing matter of the ala with a modified Préaux flap technique allows obtaining a simple, reliable, and elegant reconstruction. It presents all the advantages of the conventional upper nasolabial flap with particular care given to the cosmetic appearance of nasal reconstruction.

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin; Skin Neoplasms; Surgical Flaps

The nasal ala, critically important in the function and appearance of the central face, has significant reconstructive demands given the lack of suitable adjacent donor tissue that can be used to repair all but the smallest surgical defects in this area. Interpolated flaps from the forehead and cheek have long been ideal reconstructive alternatives for the repair of larger or more difficult alar wounds, and with the design and execution modifications described here, the dermatological surgeon can offer more appropriate restoration of this critically important aesthetic unit.

Topics: Carcinoma, Basal Cell; Cheek; Connective Tissue; Forehead; Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Relatively deep and complex surgical defects, particularly when adjacent to or involving free margins, present significant reconstructive challenges. When the use of local flaps is precluded by native anatomic restrictions, interpolation flaps may be modified to address these difficult wounds in a single operative session.. To provide a framework to approach difficult soft tissue defects arising near or involving free margins and to demonstrate appropriate design and execution of single-stage interpolation flaps for reconstruction of these wounds.. Examination of our utilization of these flaps based on an anatomic region and surgical approach.. A region-based demonstration of flap conceptualization, design, and execution is provided.. Tunneled, transposed, and deepithelialized variations of single-stage interpolation flaps provide versatile options for reconstruction of a variety of defects encroaching on or involving free margins. The inherently robust vascularity of these flaps supports importation of necessary tissue bulk while allowing aggressive contouring to restore an intricate native topography. Critical flap design allows access to distant tissue reservoirs and placement of favorable incision lines while preserving the inherent advantages of a single operative procedure.

Topics: Cartilage; Ear, External; Face; Facial Neoplasms; Humans; Lip; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps

The paramedian forehead flap (PFF) is a well-established technique for reconstruction of large nasal defects. The literature has provided several technical advances and procedural nuances that expand the surgeon's options when performing this procedure.. The objective is to provide procedural nuances, technical tips, and suggestions for improving flap outcomes. Specific techniques such as extending flap length below the orbital rim, avoiding terminal scalp hair inclusion in the flap design, restoring lining to full-thickness defects, and even flap dressings and wound care are detailed here. Of particular importance, the 3-staged turnover forehead flap for wounds requiring nasal lining, with delayed flap sculpting and cartilage graft placement, has revolutionized the conceptual approach to the most complicated nasal defects, and the technique is described in detail.. This article includes the techniques and approaches from 3 different surgeons at 3 different institutions with 3 different training backgrounds, in an effort to provide a nuanced and broad overview of the subject matter.. The PFF technique has been refined with increasing procedural variations and nuances in technique. The nasal reconstructive surgeon, armed with knowledge of these techniques, can approach each patient with a broad knowledge base and perform reconstruction with maximum success.

Topics: Bandages; Carcinoma, Basal Cell; Follow-Up Studies; Forehead; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Scalp; Skin Neoplasms; Surgical Flaps

Topics: Aged; Drug Eruptions; Granuloma, Pyogenic; Humans; Indoles; Male; Melanoma; Nose; Skin Neoplasms; Sulfonamides; Vemurafenib

Topics: Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Middle Aged; Mohs Surgery; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Nasolabial flaps have been widely used for nasal reconstruction. However, transposition of the nasolabial flap to lower nasal defects may be challenging because of functional and aesthetic concerns. The upper part of the alar crease joins with the nasolabial fold seamlessly, forming the nasolabial-alar crease line, which provides a natural strategy for easy concealment of the surgical scar. In this article, we would like to introduce a method for transferring a nasolabial flap along the nasolabial-alar crease to reconstruct lower nasal defects.. Incision was made along the nasolabial-alar crease, and the nasolabial flap was transferred for lower nasal reconstruction in 9 patients. Subcutaneously based nasolabial flaps were designed, and undermining of the superolateral skin was made along the nasolabial-alar crease to obtain a robust subcutaneously based pedicle, so as to readily achieve flap transposition without tension and concealment of the subcutaneous pedicle. The nasolabial fold could be reproduced by closing the donor site.. Lower nasal defects were successfully repaired with nasolabial flap in 9 patients. Good nasal contour and appropriate symmetry of the reconstructed nasolabial fold were achieved, and there were no conspicuous scars in the 9 cases.. The natural nasolabial-alar crease can serve as a useful incision line to facilitate the nasolabial flap transposition for lower nasal reconstruction while minimizing the scar.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Lip; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

To study a surgical and repairing method for defects after the resection of basal cell carcinoma of external nose.. There are 26 cases of basal cell carcinoma that tumors have been resected completely after operation. For defect repairing in those 26 cases, 2 cases adopt direct suture method; 2 cases use skin graft repairing methods; 18 cases employ naselabial skin flap repairing method; 4 cases choose forehead pedicle skin flap repairing methods.. the wound of all the 26 cases was primary healed. Additionally, skin flap and skin graft were all survived. Follow-up studied in patients 1 to 3 years after the surgery showed that the local scar was not obvious and no tumor recurred or transferred.. Different surgical and repairing methods are performed to obtain a satisfactory results based on the area of defect and its location in nose. Naselabial skin flap is especially an ideal method to repair defects.

Topics: Carcinoma, Basal Cell; Cicatrix; Forehead; Humans; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Wound Healing

Topics: Carcinoma, Basal Cell; Female; Humans; Male; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Carcinoma, Basal Cell; Female; Humans; Male; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Basal cell carcinoma is a malignant skin tumor with high incidence in our country, especially in rural areas, on sun-exposed skin (particularly on the face) in elderly patients. We present three cases of basal cell carcinoma with good results with cryotherapy. This report aims to outline and to prove that in some difficult situations, a simple, inexpensive, easy-to-perform procedure with no contraindications and with minimal side effects (erythema, mild pain) can be applied and resolve such cases.

Topics: Aged; Aged, 80 and over; Biopsy; Carcinoma, Basal Cell; Cryotherapy; Ear, External; Female; Foot; Humans; Nose; Skin Neoplasms

Topics: Aged, 80 and over; Biopsy; Carcinoma, Merkel Cell; Diagnosis, Differential; Disease Progression; Humans; Male; Nose; Positron-Emission Tomography; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Facial Neoplasms; Female; Health Knowledge, Attitudes, Practice; Health Status; Humans; Mohs Surgery; Nose; Skin Neoplasms

The ala is a cosmetically and functionally important portion of the nose and its reconstruction represents a surgical challenge. This article reviews the reconstructive options for alar wounds.

Topics: Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms

Xeroderma pigmentosum is a rare genetic disorder, characterized by cutaneous, ocular and neurological symptoms. Squamous cell carcinoma and melanoma are also its secondary characters. This case report is about maxillofacial prosthetic management of a 10 years old child presented with xeroderma pigmentosum. The nose of the patient was excised surgically due to melanoma. This case report elaborates the role of prosthodontist and the whole procedure of constructing the nasal prosthesis via conventional technique by using the patient's sibling nasal form as template. Regular follow up revealed marked improvement in esthetics, function and ultimately patient's quality of life.

Topics: Carcinoma, Squamous Cell; Child; Face; Humans; Male; Melanoma; Nose; Plastic Surgery Procedures; Prostheses and Implants; Prosthesis Design; Skin Neoplasms; Treatment Outcome; Xeroderma Pigmentosum

Topics: Adolescent; Diagnosis, Differential; Humans; Male; Nevus, Sebaceous of Jadassohn; Nose; Skin Neoplasms

Fibrous papules of the face are frequent benign lesions seen in the nasal and perinasal region. Their clinical aspect is indistinct and the histological signs are sometimes mild or possibly misleading in the case of atypical forms. We carried out a retrospective study of 283 fibrous papules diagnosed at our histology laboratory. The goal of this study was to characterize this type of frequent but occasionally unrecognized lesion.. We performed a retrospective study of fibrous papules of the face diagnosed in the dermatopathology laboratory of our dermatology centre between January 2002 and December 2011. The study concerned the clinical information noted in the examination request and the morphological abnormalities seen at optical microscopy. An immunohistological study of factor XIIIa was performed in selected cases.. The fibrous papules of the face came from 129 men and 154 women aged between 18 and 90 years (mean: 46 years). Two hundred and thirty-seven (83.7%) lesions were taken from the nasal region and none were taken from anywhere other than the face. The clinically mentioned diagnoses varied. A diagnosis of fibrous papule of the face was stated in 42% of cases, and the main differential diagnoses were nevus (stated in 34% of cases) and basal cell carcinoma (stated in 14% of cases). The fibrous papules were classic in 85.5% of cases. We observed 6 variants of fibrous papule: hypercellular, inflammatory, pleomorphic, pigmented, clear-cell and granular-cell types. Immunohistochemistry of factor XIIIa was positive in all cases except clear-cell fibrous papules.. This study shows that despite their frequency, these lesions often go unrecognized, since the hypothesis of a fibrous papule of the face was mentioned in fewer than 50% of cases at the time of biopsy. Diagnosis is often made by the histopathologist, who may be misled by some rare types. The principal differential diagnoses are nevus and basal cell carcinoma, thus warranting methodical histological analysis of all pieces.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Carcinoma, Basal Cell; Collagen; Diagnosis, Differential; Facial Dermatoses; Factor XIIIa; Female; Fibrosis; France; Humans; Male; Middle Aged; Nevus; Nose; Retrospective Studies; Skin Diseases, Papulosquamous; Skin Neoplasms; Staining and Labeling; Young Adult

To investigate and compare the effectiveness of perichondrial cutaneous graft (PCCG) of dorsal auricle for repairing defect after excision of melanocytic nevus in different parts of the face.. Between February 2008 and October 2012, 29 cases of facial melanocytic nevus were admitted. There were 11 males and 18 females, aged 3-25 years (median, 11 years). The locations were the upper eyelid in 5 cases, the nose in 15 cases, and the buccal region in 9 cases. The size of the nevi ranged from 1.2 cm x 1.0 cm to 4.0 cm x 2.2 cm. Defects after excision of nevi were repaired by PCCG of the dorsal auricle, which size ranged from 1.5 cm x 1.5 cm to 4.2 cm x 2.5 cm. The postoperative effectiveness was scored by patients according to color match, scar formation, and flatness of the reception site. The satisfaction evaluations were compared by the score among different parts.. All the PCCG survived. All the patients were followed up 7-15 months (mean, 10 months). All the reception site had good color match and acceptable scar formation. The nasal part had good flatness, and the upper eyelid had poor flatness. Score comparison showed no significant difference in color match between 3 parts (P > 0.05). Nasal part had significantly less scar formation than buccal region and upper eyelid (P < 0.05), but no significant difference between buccal region and upper eyelid (P > 0.05). Nasal part and buccal region both had significantly better flatness than upper eyelid (P < 0.05), but no significant difference between nasal part and buccal region (P > 0.05). The overall evaluation score of nasal part and buccal region was significantly higher than that of the upper eyelid group (P < 0.05), and the score of the nasal part was significantly higher than that of the buccal region (P < 0.05).. PCCG of dorsal auricle has a good color match in repair of facial defect, especially in repair of nasal defect with good flatness and no obvious scar formation.

Topics: Adolescent; Adult; Child; Child, Preschool; Ear, External; Face; Facial Neoplasms; Female; Humans; Male; Nevus, Pigmented; Nose; Plastic Surgery Procedures; Skin; Skin Neoplasms; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps; Treatment Outcome; Wound Healing; Young Adult

analyze the importance of the myocutaneous flap of nasalis muscle of the nose in the reconstruction of skin defects of the nasal tip. This is a retrospective study concerning 15 patients treated from 2010 to december 2012 for basal cell carcinomas of the nasal tip. The minimum follow up was 6 months. We describe the procedure and the indications. The best site to be proposed for this flap is beyond question the latero-medial part of the nasal tip. It can be adapted to skin defects as large as 15 mm. Obviously since it is a skin island flap it is important to respect the pedicle between it and the nasalis muscle. The closure of the donor site is done in the alar-facial sulcus with a VY suture and scarring on this level is very negligible. We analyzed the aesthetic result which is often very good. One advantage of this flap is not to change the architecture of the nasal ala.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Myocutaneous Flap; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Dental Care; Female; Humans; Nose; Skin Neoplasms

Head and neck melanomas (HNMs) are frequent and have a poorer prognosis than melanomas at other sites. Photoprotection in these locations is difficult. In this population-based study of 279 HNMs diagnosed in a French region between 2004 and 2009, major differences were found between genders. A clearcut, sex-related distribution was found between a "peripheral" area (scalp, forehead, temples, ears, and neck) and a "central" one (other parts of the face), with 56.7% of HNMs being located in the peripheral area in men and 79.3% in the central area in women (P<0.0001). Moreover, HNMs located in the peripheral area occurred on the left side in 57.6% of men and on the right side in 73.1% of women (P=0.009). Peripheral HNMs differed from central HNMs by a higher proportion of invasive tumors, nodular or superficial spreading melanomas, and a lower proportion of lentigo maligna melanomas (LMMs). We hypothesized that this differential distribution between men and women could be explained mostly by a major role of long-term photoprotection by hair and sun exposure in a car. Important public health messages could result from these observations, such as the role of hairstyles in melanoma prevention and the importance of reducing sun exposure in a car, particularly in professional drivers.

Topics: Adult; Aged; Aged, 80 and over; Automobiles; Cheek; Ear; Female; Forehead; Hair; Head; Head and Neck Neoplasms; Humans; Incidence; Male; Melanoma; Middle Aged; Neck; Neoplasms, Radiation-Induced; Nose; Registries; Retrospective Studies; Sex Factors; Skin Neoplasms; Ultraviolet Rays

Reconstruction of nasal defects is an antique challenge for surgeons. The first reported technique is dated 600 B.C. Since then a number of reconstructive options have been proposed in the literature. Some principles, first stated by Buget and Menick must be always taken into account when planning such reconstructions. In detail, every reconstruction should respect the subunit principle and the scars should always be well hidden in the passage between adjacent subunits. The flap proposed in the present paper adheres to the cited principles and leads to optimal nasal dorsum reconstruction in selected cases.. From April 2008 to March 2009, 5 patients were reconstructed with Lemmo's flap after local excision of 3 basal cell carcinomas and 2 squamous cell carcinomas affecting the the skin of the nasal dorsum in its caudal portion.. In all cases a pleasing aesthetic result was obtained, no postoperative deformity was observed and all the scars were unnoticeable.. The Lemmo's flap described in the present paper can be considered a valid choice for nasal dorsum skin reconstruction and is preferable over other techniques for reconstruction of small to medium sized defects of the skin of the caudal dorsum.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Esthetics; Female; Humans; Male; Nose; Nose Deformities, Acquired; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Esthetics; Humans; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome; Wound Healing

The bilobed and hatchet flaps are well-accepted reconstructive options for the correction of defects of the lower third of the nose. Optimal utilization of these flaps depends on understanding the characteristics of each flap as well as anatomic considerations related to the distal nasal area. Disregarding the limitations of either method may lead to flap failure and unacceptable aesthetic results.. We present three original ideas: 1) a bilobed flap may be considered as a hatchet flap with a Z-plasty; 2) the trap door deformity (TDD) associated with a bilobed flap can be used as an advantage; and 3) an easy method for preoperative planning of a bilobed flap.. We collected data from patients who underwent excision of basal cell carcinoma (BCC) of the distal third of the nose and reconstruction with a hatchet or a bilobed flap within the last 20 years.. Favorable cosmetic results were achieved when a hatchet flap was used to reconstruct defects of the inferior third of the nasal side wall, above or bordered with the alar crease, and when a bilobed flap was used to reconstruct nasal tip para-medial defects above the lower lateral cartilage convexity.. We suggest choosing between the hatchet and bilobed flaps for nasal reconstruction according to the defect location as outlined by our findings.

Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Nose; Plastic Surgery Procedures; Retrospective Studies; Skin Neoplasms; Surgical Flaps

Surgical reconstruction of defects on the lower half of the nose mandates special considerations. Simple excision and suturing might cause a depressed scar and nostril flaring. Hence, the preoperative plan should be designed properly to avoid disfigurement and to achieve a successful reconstruction.. Three basic reconstructive concepts are essentially combined: 1.) The ratio between scar length and defect diameter should be extended beyond the standard 3:1 ratio; 2.) The defect should be positioned asymmetrically within the inferior half of the excision outline; and 3.) Para-median defects mandate an inferior, horizontal advancement ("sliding") flap to avoid nostril flaring. A salvage technique is also discussed.. Data from patients treated by Mohs micrographic surgery for tumors of the inferior aspect of the nasal dorsum and reconstructed according to the proposed course of action was collected and reviewed.. The proposed reconstructive path proved successful for all patients. Although one case required salvage skin grafting, all patients had aesthetically pleasing results. No postoperative complications were noted.. Simple excision and primary suturing is a viable method for treating lesions on the lower half of the nose, provided that the surgeon follows a set of basic reconstructive principles.

Topics: Humans; Mohs Surgery; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Neurothekeoma is a rare neoplasm assigned to the broad category of benign peripheral nerve sheath tumors. Its cell of origin is still unknown, but most ultrastructural and immunohistochemical studies have favoured the Schwann cell perineurium or fibroblast. Neurothekeoma most commonly presents in females, especially in the second and third decades of life. Typically it presents as an asymptomatic solitary, firm, flesh-coloured or hyperpigmented slow-growing papule or nodule that involves the skin and superficial subcutis. It usually involves the face, neck, arm or shoulder but can also involve extracutaneous sites. Neurothekeoma occurs in myxoid (classic), cellular and intermediate (mixed) variants. Here, we report a 45-year-old male patient presenting with a nodule on the nose that was found to be a myxoid variant of neurothekeoma. It was treated with a simple shave excision followed by removal of the lobulated deeper part by forceps. He had no recurrence after three years of follow-up. To the best of our knowledge, this is the first case of a myxoid neurothekeoma of the nose to be reported in the Middle East.

Topics: Humans; Male; Middle Aged; Neurothekeoma; Nose; Skin Neoplasms

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Lip; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Aged; Biopsy; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms

Reconstructive techniques for extended posttraumatic or post-resectional nose defects are well described. Small defects can usually be closed using local flaps with a good esthetic result. Extended resections in the mentioned area require more complex reconstruction methods, including microvascular techniques. The Authors' presented a case of whole nose and partial cheek simultaneous reconstruction using three free flaps. Two auricular free flaps and one radial forearm free flap were used to cover the defect. Meticulous preoperative planning and harvesting of flaps enabled to achieve good esthetic and functional results.

Topics: Adult; Anastomosis, Surgical; Carcinoma, Basal Cell; Free Tissue Flaps; Humans; Male; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Young Adult

Defects of the distal nose and nasal tip are inherently challenging to reconstruct. Although the bilobed flap has a pivotal role for the closure of such defects to achieve a satisfactory outcome, it demands meticulous planning and execution.. We sought to present our experience of the advancement and inferior rotation of the nasal sidewall (AIRNS) flap as a possible alternative to the bilobed flap for reconstruction of the distal nose.. All patients who underwent AIRNS repair after Mohs tumor extirpation of the nose at 2 regional skin cancer units since April 2011 were reviewed.. In all, 45 patients underwent the AIRNS flap repair. There were 25 men and 20 women, with a mean age of 70 years (range 41-88). The average defect size was 1.2 × 1.2 cm. The majority of cases involved the nasal tip. A single case of postoperative infection occurred in a smoker, which resolved without any long-term sequelae. No cases of flap necrosis or nasal airflow obstruction were seen. All cases produced good or excellent cosmetic results.. Because of blunting of the superior alar crease, which may be avoided in a bilobed repair, the AIRNS flap is best avoided in laterally based defects of the nasal alar.. The AIRNS flap is a reliable, single-stage closure option that, in our opinion, is simpler in design and execution compared with the bilobed flap and thus adds to the reconstructive surgeon's armamentarium when faced with centrally located defects of the distal nose.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Postoperative Complications; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

A basal cell carcinoma can invade the cartilage in the nasal ala and can reach the nasal vestibule skin. A full-thickness reconstruction of the nasal ala is required to repair the tissue damage after tumor removal. We combined an auricular composite graft with a nasolabial flap to repair the defects in the nasal ala.. Eleven patients with full-thickness infiltration of the nasal ala by basal cell carcinoma were included in the study. The outer defect area after tumor removal ranged from 1.5 × 2.0 to 2.0 × 2.5 cm(2). Skin-cartilage composite grafts 1.5 × 1.5 to 1.5 × 2.0 cm(2) in size were harvested from the helix at the top of the ear. The composite graft was used as a support scaffold to reconstruct the defects. A nasolabial flap was used to cover the cartilage.. All cases were treated successfully. No flap necrosis, skin color changes, or blistering occurred. The shape of the flap was stable, and the skin color was consistent with that of the surrounding tissue. The reconstructed nasal ala was symmetrical.. Combining an auricular composite graft with a nasolabial flap can repair defects up to 2.0 × 2.5 cm(2) in size. The reconstructed nasal ala matches the original skin color and maintains the appropriate shape.

Topics: Carcinoma, Basal Cell; Ear Auricle; Female; Humans; Male; Middle Aged; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

To illustrate the safety, efficacy, and versatility of the antihelix as the preferred donor site for auricular cartilage autografts in the reconstruction of nasal and auricular Mohs micrographic surgery defects.. Retrospective chart review of all cartilage autografts performed at the Medical University of South Carolina for the 5-year period July 1, 2006, to June 30, 2011; 307 auricular cartilage autografts were performed in 297 patients. Each case was reviewed for demographic data, graft donor site, repair type, complications, and revisions.. Three hundred five of the grafts (99.3%) were harvested from the antihelix and the remaining two (0.7%) from the conchal bowl. The donor site complication rate was 3%. No patients experienced cosmetic or functional deformity of the donor ear. No patients experienced cartilage graft resorption or infection.. Antihelical cartilage grafts can serve as safe, effective, and versatile alternatives to septal, conchal bowl, and costal margin grafts. The authors feel strongly that the antihelix donor site should be favored when harvesting auricular cartilage for its easy accessibility, large dimension that may be harvested without aesthetic penalty, character of graft, and minimal operative morbidity.

Topics: Ear Auricle; Ear Cartilage; Female; Humans; Male; Mohs Surgery; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Male; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Various treatment options are available for basal cell carcinoma (BCC). We report a case of a patient with a nodular BCC on the nose who was treated with combination therapy consisting of cryotherapy with liquid nitrogen followed by imiquimod cream 5% 5 times weekly for 6 weeks. Clearance of the lesion was histologically confirmed.

Topics: Aged, 80 and over; Aminoquinolines; Antineoplastic Agents; Carcinoma, Basal Cell; Combined Modality Therapy; Cryotherapy; Facial Neoplasms; Humans; Imiquimod; Male; Nose; Skin Neoplasms

The authors report an unusual case of intrafollicular collagenous crystalloids in an 86-year-old woman. The presence of collagenous crystalloids within the follicular epithelium is intriguing and has not been described previously.

Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Collagen; Crystallization; Crystalloid Solutions; Diagnosis, Differential; Female; Hair Diseases; Hair Follicle; Humans; Isotonic Solutions; Nose; Skin Neoplasms

Topics: Aged, 80 and over; Biopsy; Diagnosis, Differential; Follow-Up Studies; Hemangiosarcoma; Humans; Male; Nose; Nose Neoplasms; Photons; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Skin; Skin Neoplasms

The reconstruction of the columella poses a significant challenge to the plastic surgeon. A multitude of techniques have been developed to address this issue; however, the end result is often unsatisfactory or comes at too high a morbid cost. Gillies described an alar margin flap in 1949 that never gained significant popularity. This technique had been refined by Servant over the past two decades in his work on Noma noses in Africa. We describe a two-stage columella reconstruction technique with a nostril alar rim threshold flap and provide the results of our case series. Under local anaesthesia, a full-thickness alar flap is raised by placing an incision along the alar-facial groove and carrying it around the lateral crus. This flap is then rotated on its medial pedicle and inserted into the nasal tip. Three weeks after the first stage, the flap is divided to the desired columellar length and the remaining ala relocated to the alar-facial groove. At the same time, the contralateral ala can be adjusted to match the donor side. We performed a retrospective study of all our columellar reconstructions using this local flap. Our case series consisted of seven patients, and satisfactory cosmetic results were obtained in all cases. The nostril alar rim threshold flap is a useful technique for columellar reconstruction, producing near-anatomic results that can be performed as a two-stage outpatient procedure under local anaesthesia. This technique is particularly well suited for columellar reconstruction in patients of African descent.

Topics: Adolescent; Adult; Aged; Cohort Studies; Esthetics; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

We present a case report of a naevoid lentigo maligna (World Health Organisation level 1 melanoma) on the nose of a 46-year-old man. He was under surveillance because of a past history of two melanomas and developed a new lesion. The visible lesion was 1.6 mm in maximum diameter as measured by the scale on the dermatoscope footplate. The dermatoscopic structures present were limited to dots arranged asymmetrically. We believe that the fact that some of these dots were grey provided a useful clue to the diagnosis of melanoma.

Topics: Dermoscopy; Humans; Hutchinson's Melanotic Freckle; Male; Middle Aged; Nose; Skin Neoplasms

surgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps.. Ninety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients.. Wound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all.. Immediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Facial Muscles; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Plastic Surgery Procedures; Prognosis; Skin Neoplasms; Surgical Flaps; Young Adult

We present three patients with major defects of the eyelid who subsequently had them reconstructed. They included a defect of the lateral upper lid, a defect of the medial upper and lower lids, and a defect of the medial lower lid, cheek, and nose.

Topics: Aged; Aged, 80 and over; Blepharoplasty; Carcinoma, Basal Cell; Cheek; Decision Making; Eyelids; Female; Humans; Male; Middle Aged; Nose; Skin Neoplasms; Wounds and Injuries

The nasal dorsum is a good skin flap donor site for alar reconstructions because of its qualities: appropriate color, texture, and thickness.. An anatomic vascular study on cadaver and the clinical use of the dorsal nasal skin flap, inferiorly based on the nasal septal branches, is reported.. Vascular anatomy of the nasal dorsum was demonstrated in five fresh-frozen latex-injected heads. Fourteen patients were operated of reconstruction of the nasal ala using an inferiorly based dorsal nasal flap.. Nasal septal branches, from the superior labial arteries, give vascular supply to the nasal tip. Connections of these arteries with lateral nasal branches (facial system) and dorsal nasal arteries (ophthalmic system) form a consistent vascular network in the dorsal nasal superficial muscular aponeurotic system and allow to safely raise cutaneous flaps distally based. No total or partial loss of the flaps was observed in clinical use. The donor site was sutured directly in 13 patients and with a skin graft in one.. The inferiorly based dorsal nasal flap provides very good cosmetic and functional results and could be considered an additional adequate surgical option for nasal ala reconstruction, especially when skin from the nasolabial fold, upper lip, and cheek is not available. The authors have indicated no significant interest with commercial supporters.

Topics: Adult; Aged; Cadaver; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

To reconstruct the cheek, surgeons will need a variety of techniques including local flaps, pedicled flaps, as well as split- or full-thickness skin grafts. Depending on the size and the location of the defect as well as possible impeding conditions (revision, previous irradiation) or extended surgery (parotid gland, cervical lymph nodes), the extent of surgery needs to be adapted. The aesthetic units in the face, the relaxed skin tension lines and the free margins of the lower eyelid, and the nasal ala and the lip need to be respected. Considering these conditions, various approaches in cheek reconstruction are discussed in this article.

Topics: Cheek; Ear, External; Esthetics; Eyelids; Facial Neoplasms; Fascia; Humans; Lip; Mandible; Muscle, Skeletal; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Physiological Phenomena; Skin Transplantation; Surgical Flaps

Surgical site infections (SSIs) after dermatologic surgery cause pain, prolong healing, result in unaesthetic complications, and lead to excessive use of antibiotics. The pathogenesis of wound infections is complex and is dependent on bacterial load and diversity, among several factors.. To investigate bacterial dynamics at dermatosurgical sites at different time intervals and assess the correlation with postoperative outcomes and to examine different endo- and exogenous factors that may contribute to SSIs.. Eighteen patients undergoing skin grafting of the face were studied. The following SSI-related factors were registered: age and sex of the patient, ulceration of the lesion, diabetes, immunosuppressive therapy, smoking, anticoagulative therapy, and use of antibiotic prophylaxis. Wounds from each patient were swabbed preoperatively, intraoperatively, and postoperatively. The bacterial composition of the swabs was then analyzed quantitatively and qualitatively.. Sixteen of 18 surgical sites contained varying quantities of surface-associated bacteria. Coagulase-negative staphylococci and Propionibacterium acnes were the predominant bacteria isolated at all times. Intraoperative analysis was not predictive of SSIs. Use of antibiotic prophylaxis was the only registered SSI-related factor that showed significant variation in bacterial load between pre- and postoperative samples. Postoperative bacterial load was found to be lower than preoperative load in patients who received antibiotics. This was in contrast to patients who did not receive antibiotics, who had significantly higher postoperative levels (p=.02). The presence of high postoperative bacterial loads, regardless of the bacterial species isolated, showed a statistically significant positive correlation with a complicated postoperative outcome (p≤.001).. This study provides novel insights into the bacterial dynamics of dermatologic surgery-induced wounds and the variation of this over time. The results highlight the potential relevance of quantifying bacterial loads, as well as determining specific types of bacteria, in dermatologic surgery.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Bacterial Load; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Facial Neoplasms; Female; Floxacillin; Forehead; Humans; Keratosis, Actinic; Male; Middle Aged; Nose; Perioperative Period; Propionibacterium acnes; Skin Neoplasms; Skin Transplantation; Skin Ulcer; Staphylococcus; Surgical Wound Infection; Treatment Outcome

Nevoid basal cell carcinoma syndrome is a genetic abnormality that often manifests with skin abnormalities and odontogenic pathology at a relatively young age. Whenever basal cell carcinoma is discovered, a more detailed history must be taken that goes back to the patient's youth. A suspicious history should lead to further follow-up. The diagnosis of NBCCS should not deter the clinician from treating the underlying skin carcinoma; rather, it should educate both the patient and the clinician that a more complex pathology exists that requires more aggressive and frequent oversight by a dermatologist.

Topics: Adult; Basal Cell Nevus Syndrome; Facial Neoplasms; Humans; Male; Military Personnel; Neoplasm Recurrence, Local; Nose; Odontogenic Cysts; Skin Neoplasms

The occurrence of neoplasms in injury scars--as consequence of occupational accidents--may lead to compensation according to the statutory accident insurance regulations. According to newer regulatory attempts in occupational dermatology, certain criteria have to be met before the diagnosis of a neoplasm induced by a scar is accepted and compensation is due.. Based on a retrospective analysis of 217 dermatological claim files between 2007 and 2009 of the IPA (including 22 follow-ups), medical opinions on neoplasms developing in possible occupational scars were re-evaluated using criteria of the German social accident insurance and the Bamberg medical bulletin, part II (Bamberger Merkblatt, BM II) to see how well they qualified for recognition as an occupational or accident-related disorder.. Three cases were identified where a neoplasm was suspected of having developed in an occupationally-related scar. One of the insured events entitled for compensation. Following the guidelines of the BM II, this case was approved as an occupational disease secondary to injuries with resultant reduction in earning capacity, whereas the others did not meet the requirements.. Two problems in evaluating malignant tumors in occupational scars are the long latency period and the documentation of a scar. The tumor excision specimen should be histologically re-examined to document the presence of an associated scar.

Topics: Accidents, Occupational; Arm Injuries; Burns; Carcinoma in Situ; Carcinoma, Basal Cell; Cell Transformation, Neoplastic; Cicatrix; Expert Testimony; Germany; Head and Neck Neoplasms; Humans; Insurance, Accident; Melanoma; Nose; Nose Neoplasms; Retrospective Studies; Skin; Skin Neoplasms; Workers' Compensation

Mucocutaneous squamous cell carcinoma (SCC) may rarely exhibit intracellular mucin production. Extracellular mucin production is an even rarer finding in SCC that is not well documented in the literature. Here, we report six cases of primary cutaneous and mucocutaneous SCC with prominent extracellular stromal mucin deposition and an epithelial spindle cell component. We propose the term 'yxoid spindle cell SCC' (MSC SCC) to describe the histologic characteristics of these six cases. We also propose a set of histologic and immunohistochemical findings for distinguishing MSC SCC from primary cutaneous and metastatic spindle cell neoplasms including other sarcomatoid carcinomas, myxoid sarcomas and the spindle cell variant of atypical fibroxanthoma (AFX). The criteria can also help discern MSC SCC from spindle cell melanomas, which may rarely show a prominent myxoid stroma. Given the small numbers of cases reported to date, the presence of prominent myxoid stroma in primary cutaneous spindle cell SCC has unknown prognostic significance at this time.

Topics: Aged; Aged, 80 and over; Arm; Biomarkers, Tumor; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Nasal Mucosa; Nose; Penis; Skin Neoplasms

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Antineoplastic Agents; Female; Humans; Immunohistochemistry; Interferon-gamma; Lymphoma, B-Cell, Marginal Zone; Metronidazole; Minocycline; Nose; Recombinant Proteins; Rosacea; Skin Neoplasms

A 55-year-old man presented with multiple, asymptomatic, yellowish papules on his face with a 4-year history, and two non-healing tumoral lesions on his nose with a 7-month history. He was a renal transplant recipient and had been treated with cyclosporine (ciclosporin) for 9 years. A biopsy from the asymptomatic, yellowish papule on the face showed sebaceous gland hyperplasia, and biopsies from the lesions on the nose revealed basal cell carcinomas. The lesions on the nose were excised. Sebaceous gland hyperplasia and skin cancers are among the cutaneous neoplasms observed in renal transplant recipients receiving cyclosporine. To our knowledge, this is the third reported case of the coexistence of basal cell carcinomas and multiple sebaceous gland hyperplasias in a cyclosporine-treated renal transplant recipient.

Topics: Carcinoma, Basal Cell; Cyclosporine; Face; Humans; Hyperplasia; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nose; Sebaceous Gland Diseases; Skin Neoplasms; Treatment Outcome

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Forehead; Humans; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Suture Techniques; Treatment Outcome

Topics: Adult; Clinical Trials as Topic; Dermatology; Drug Interactions; Ear; Epinephrine; Evidence-Based Medicine; Fingers; Humans; Information Dissemination; Lidocaine; Male; Necrosis; Nose; Penis; Plastic Surgery Procedures; Research Design; Skin Diseases; Skin Neoplasms; Surgical Procedures, Operative; Suture Techniques; Young Adult

Topics: Adult; Facial Neoplasms; Female; Forehead; Humans; Lip; Male; Mohs Surgery; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Facial Neoplasms; Humans; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Adult; Biopsy; Eyelids; Female; Forehead; Humans; Lentigo; Nevus of Ota; Nose; Skin Neoplasms

Skin cancers of the nasal tip present a challenge for the dermatologic surgeon. The bilobed flap has been widely used as the "workhorse" flap for such defects but requires meticulous design and may be complicated by a tendency toward pin-cushioning.. To describe the use of the nasal sidewall rotation (NSR) flap for reconstructing defects on the nasal tip.. A retrospective analysis of the Mohs micrographic surgery database over a 4-year period was performed. All cases in which the NSR flap was used were identified. Defect location and size and any postoperative complications were noted. All patients were reviewed at the time of suture removal and at 6 weeks.. There were 65 cases (19 men and 46 women). Age ranged from 39 to 86 (mean 60.5, median 59). Defect size varied from 0.4 to 2.0 cm in diameter, with 63% measuring 1.0 to 1.4 cm. Good to excellent results were seen in all patients, and postoperative complications were uncommon and minor. CONCLUSION The NSR flap is a versatile and useful alternative for reconstructing surgical defects of the nasal tip. The authors have indicated no significant interest with commercial supporters.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Dermatologic Surgical Procedures; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Retrospective Studies; Skin Neoplasms; Surgical Flaps; Treatment Outcome

The bilobed flap is reliable for reconstruction of Mohs defects on the lower third of the nose. It uses skin from the proximal nose to reconstruct defects of the nasal tip and ala. The goal is to avoid alar rim displacement and asymmetry. The trilobed flap's design and execution leverage the strengths of the bilobed flap to allow application to a broader range of surgical nasal defect sizes and locations, particularly distal defects.. To present our surgical execution and application of the trilobed flap for reconstruction of distal nasal Mohs surgery defects.. Mohs surgery defects of the distal nose of 31 patients were reconstructed using a trilobed flap over a 3-year period. Pre- and postoperative photographs were independently and blindly evaluated and graded for alar symmetry and overall cosmesis.. Median alar symmetry and overall cosmesis scores based on three reviewers were excellent.. The trilobed flap offers a successful reconstructive option for Mohs defects of the distal nose that may not be optimally amenable to bilobed flap repair. Over 3 years, 31 trilobed flap repairs were performed with overall excellent outcomes.

Topics: Adult; Female; Humans; Male; Mohs Surgery; Nose; Nose Deformities, Acquired; Nose Neoplasms; Plastic Surgery Procedures; Retrospective Studies; Skin; Skin Neoplasms; Surgical Flaps; Wounds and Injuries

Topics: Acanthoma; Aged; Biopsy, Needle; Black or African American; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Immunohistochemistry; Mohs Surgery; Nose; Skin Diseases, Papulosquamous; Skin Neoplasms; Treatment Outcome

Topics: Administration, Topical; Aminoquinolines; Biopsy, Needle; Female; Follow-Up Studies; Humans; Hutchinson's Melanotic Freckle; Imiquimod; Immunohistochemistry; Melanoma, Amelanotic; Middle Aged; Neoplasm Recurrence, Local; Nose; Risk Assessment; Skin Neoplasms; Treatment Outcome

Adjacent defects are commonly encountered during Mohs micrographic surgery for nasal skin cancers and often present a formidable reconstructive challenge.. This article will describe similar modifications of both the bilobed and nasolabial transposition flaps' Burow's triangles that allow for the repair of two adjacent defects of the distal nose using a single flap.. This is a report of two similar reconstructive cases after Mohs micrographic surgery requiring the repair of adjacent nasal defects.. Both cases demonstrate the feasibility of this technique.. This technique is based on two case reports.. Traditional transposition flaps' Burow's triangles can be effectively modified for the repair of properly selected adjacent wounds of the distal nose.

Topics: Aged; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

A proportion of individuals are affected multiple times by basal cell carcinoma (BCC), but the rate and extent to which this occurs is unknown. We therefore prospectively estimated BCC incidence in a subtropical Australian population, focusing on the rate at which persons develop multiple primary BCCs and the precise anatomic sites of BCC occurrence. Between 1997 and 2006, 663 BCCs were confirmed in 301 of 1,337 participants in the population-based Nambour Skin Cancer Study. The incidence of persons affected multiple times by primary BCC was 705 per 100,000 person years compared to an incidence rate of people singly affected of 935 per 100,000 person years. Among the multiply and singly affected alike, site-specific BCC incidence rates were far highest on facial subsites, followed by upper limbs, trunk, and then lower limbs. We conclude that actual BCC tumor burden is much greater in the population than is apparent from normal incidence rates. Anatomic distribution of BCC is consistent with general levels of sun exposure across body sites.

Topics: Adult; Carcinoma, Basal Cell; Cheek; Ear, External; Face; Female; Forehead; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Nose; Queensland; Skin Neoplasms; Sunlight

Clear-cell changes are rare in histological specimens of the dermis and raise complex diagnostic considerations regarding lineage differentiation (e.g., epithelial, mesenchymal, or melanocytic). We present a clear-cell atypical fibroxanthoma (CCAFX) and describe the morphological and immunohistochemical aspects of this rare skin lesion. Furthermore, we give an overview of the differential diagnoses of clear-cell lesions of the skin for a practical approach.

Topics: Aged, 80 and over; Biomarkers, Tumor; Diagnosis, Differential; Female; Histiocytoma, Benign Fibrous; Humans; Immunohistochemistry; Nose; Skin Neoplasms

Extranodal nasal-type natural killer/T-cell lymphoma presenting in skin, either primary or secondary, is relatively rare in China, accounting for about 4.1% of tumors. The clinicopathologic features of the neoplasm are still poorly understood. Sixteen Chinese cases of cutaneous natural killer/T-cell lymphomas were investigated retrospectively by pathology, immunophenotype, genotype, Epstein-Barr virus status, and survival analysis. The mean age of the patients was 36.3 years; 81% of the patients presented with multiple cutaneous lesions. Angiocentricity and epidermotropism were observed in 43.7% and 25%, respectively; the average number of mitoses was 12 per 10 high-power fields. The neoplastic cells of all 16 cases were positive for CD3varepsilon/CD45RO and granzyme B and negative for CD4, CD5, CD8, and CD20; 87.5% of the tumors expressed CD56. Signals for EBER were detected in 81.3% of cases. No clonal TCRgamma/TCRbeta gene rearrangement was demonstrated. Thirteen of 15 patients received chemotherapy; a partial response was achieved in 10 patients; 10 (66.7%) of 15 patients died of the disease, and the average survival time was 6.6 months. In conclusion, both primary and secondary cutaneous natural killer/T-cell lymphomas are highly aggressive. The outcome is closely related to the number and distribution of the lesions as well as the stage. In patients with generalized skin lesions and extracutaneous involvement, the prognosis usually is poor.

Topics: Adolescent; Adult; Aged; China; Female; Humans; Killer Cells, Natural; Lymphoma, T-Cell; Male; Middle Aged; Nose; Nose Neoplasms; Retrospective Studies; Skin Neoplasms

Proper selection of reconstruction method is the key point to get a successful result in nasal reconstruction. The purposes of this study are to report the author's experience and to present a surgical algorithm in reconstruction of the nasal defects in Asian.. Retrospective medical record analysis was performed for 40 patients who underwent nasal reconstruction between March 1996 and February 2006 at a tertiary referral hospital. Male to female ratio was 24:16, average age was 56 years, and average follow-up period was 25 months. Etiology, location, size, reconstruction method and surgical results were analyzed.. Majority of the defects (36/40) resulted from resection of a neoplasm. Among tumors, basal cell carcinoma accounted for 75% (27/36) followed by squamous cell carcinoma 8% (3/36). The defect was located in the dorsum in 11 cases, lateral wall in 9, ala in 8, tip in 4, and involved more than two sites in 8. In 2/3 of the cases, the defect size was less than 2cm. Local flap was used in 29 cases, primary closure in 6 cases, and skin graft in 5 cases. Among local flaps, nasolabial flap was useful for defects of the ala and multiple subunits while large nasal tip defects needed forehead flap. Transposition flaps were used for the small to medium sized defects of the nasal sidewall or dorsum. Reinforcement cartilage graft was used in 9 cases. Second stage refinement procedure was performed in 2 patients. Partial necrosis resulted in 2 cases but none ended up in total loss.. A local flap is the most versatile method for reconstruction of cutaneous defects of the Asian nose. The site and size of the defect are key considerations in choosing the local flap. Asian skin characteristics influence the design, execution, and the outcomes of the local flap.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Asian People; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Child; Dermatologic Surgical Procedures; Female; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Retrospective Studies; Skin; Skin Neoplasms; Surgical Flaps; Surgical Procedures, Operative; Young Adult

A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Eyelid Neoplasms; Eyelids; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Skin Neoplasms; Skin Pigmentation; Skin Transplantation; Subcutaneous Tissue; Surgical Flaps; Tissue and Organ Harvesting; Wound Healing

Nasal reconstruction has key functional aims of achieving an optimal esthetic result while maintaining a patent airway. For the distal third of the nose, these goals are achieved by replacement of lining, osseocartilaginous support, and soft tissue coverage. The use of skin tags for reconstruction of the ear have been well documented, yet to our knowledge, there are no reported cases of their use in reconstruction of the nose. Skin tags, also referred to as acrochordon, fibroepithelial polyps, and pedunculated fibromas are benign soft, fleshy, sessile, or pedunculated lesions ranging from 1 to 5 mm in diameter. We report a novel approach to distal nasal reconstruction that arose opportunistically as a result of coincident pathologies.

Topics: Cartilage; Craniofacial Abnormalities; Eyelids; Female; Humans; Infant, Newborn; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation

Topics: Esthetics; Female; Humans; Male; Mohs Surgery; Nose; Nose Neoplasms; Organ Size; Photography; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Wounds and Injuries

Topics: Blood Loss, Surgical; Equipment Design; Hemostasis, Surgical; Humans; Nose; Otorhinolaryngologic Surgical Procedures; Skin Neoplasms; Treatment Outcome

Topics: Aged, 80 and over; Antineoplastic Agents; Carcinoma, Basal Cell; Chlorides; Drug Combinations; Herbal Medicine; Humans; Male; Necrosis; Nose; Phytotherapy; Plant Preparations; Sanguinaria; Skin Neoplasms; Zinc Compounds

Although several methods can be used to perform midface reconstruction, difficulties exist in selecting the appropriate method because of anatomic and functional complexities, donor site morbidities, and poor esthetic results. The purpose of this study was to develop an alternative reconstructive method for the midface using various flaps based on the angular artery.. We investigated the relation between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by use of island composite nasal flaps.. The angular artery was reliable as a pedicle whether it was used in an antegrade or retrograde manner. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The esthetic outcomes for the donor and recipient sites were acceptable.. The angular artery has diverse relations with its surrounding structures according to its course of travel, and if the surgeon has a precise understanding of its anatomic location, we believe that retroangular flaps and island composite nasal flaps may prove useful for the treatment of midface defects.

Topics: Aged; Aged, 80 and over; Arteries; Cadaver; Carcinoma, Basal Cell; Dissection; Esthetics; Eyelid Neoplasms; Eyelids; Face; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting; Treatment Outcome

Topics: Biopsy, Needle; Cell Transformation, Neoplastic; Dermoscopy; Disease Progression; Follow-Up Studies; Humans; Hutchinson's Melanotic Freckle; Immunohistochemistry; Male; Middle Aged; Neoplasm Staging; Nose; Skin Neoplasms; Treatment Refusal

After a life-threatening complication of an injection for neck pain several years ago, Ms W experienced a wrong-site surgery to remove a squamous cell lesion from her nose, followed by pain, distress, and shaken trust in clinicians. Her experience highlights the challenges of communicating with patients after errors. Harmful medical errors occur relatively frequently. Gaps exist between patients' expectations for disclosure and apology and physicians' ability to deliver disclosures well. This discrepancy reflects clinicians' fear of litigation, concern that disclosure might harm patients, and lack of confidence in disclosure skills. Many institutions are developing disclosure programs, and some are reporting success in coupling disclosures with early offers of compensation to patients. However, much has yet to be learned about effective disclosure strategies. Important future developments include increased emphasis on institutions' responsibility for disclosure, involving trainees and other team members in disclosure, and strengthening the relationship between disclosure and quality improvement.

Topics: Carcinoma, Squamous Cell; Communication; Ethics, Medical; Fear; Female; Humans; Medical Errors; Middle Aged; Nose; Physician-Patient Relations; Physicians; Quality of Health Care; Skin Neoplasms; Truth Disclosure

Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. There are few local nasal flap options for the repair of proximally positioned nasal skin defects.. During a 3-year period, 22 patients were treated after excision of skin cancer in the proximal two-thirds of the nose. Nine patients (41%) were female and 13 (59%) were male, with an average age of 69 years. All patients were operated on under local anesthesia. The average follow-up was 25 months.. In all patients, after tumor ablation, the skin defect was closed with an island composite nasal skin flap. Pathohistologic analysis confirmed that the margins of the removed tumor were free of malignant cells. Six patients (27.3%) had squamous cell and 16 (72.7%) had basal cell carcinoma. There was no total or partial flap loss. None of the patients has suffered from recurrence of the tumor.. The island composite nasal flap is a reliable technique for the closure of proximal nasal skin defects. Complications in the elevation of the island composite flap were rare, and the final result was acceptable.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

Topics: Antineoplastic Combined Chemotherapy Protocols; CD56 Antigen; Connective Tissue Diseases; Cyclophosphamide; Diagnostic Errors; Doxorubicin; Epstein-Barr Virus Infections; Eyelid Neoplasms; Fatal Outcome; Female; Herpesvirus 4, Human; Humans; Immunophenotyping; Killer Cells, Natural; Lymphoma, Non-Hodgkin; Lymphoma, T-Cell, Cutaneous; Male; Nose; Prednisolone; Skin; Skin Neoplasms; T-Lymphocyte Subsets; Vincristine; Young Adult

Topics: Carcinoma, Basal Cell; Female; Humans; Middle Aged; Nose; Photochemotherapy; Skin Neoplasms; Treatment Outcome

Topics: Adolescent; Cicatrix; Female; Humans; Nevus; Nose; Nose Neoplasms; Plastic Surgery Procedures; Reoperation; Skin Neoplasms; Skin Transplantation

Topics: Carcinoma, Basal Cell; Humans; Hutchinson's Melanotic Freckle; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps; Wounds and Injuries

Rhinophyma, the end stage in the development of acne rosacea, is characterized by sebaceous hyperplasia, fibrosis, follicular plugging, and telangiectasia. Although it is commonly considered a cosmetic problem, it can result in gross distortion of soft tissue and airway obstruction. Basal cell carcinoma (BCC) is a rare finding in patients with rhinophyma. The objective of this study is to review the literature of BCC in rhinophyma and report on a case. A 70-year-old male presented with long-standing rosacea that resulted in a gross nasal deformity. The patient suffered from chronic drainage and recurrent infections that failed conservative treatment with oral and topical antibiotics. The patient decided to proceed with surgical intervention and underwent tangential excision and dermabrasion in the operating room. Since 1955 there have been 11 cases reported in the literature. In our case, the pathology report noted that the specimen had an incidental finding of a completely resected BCC. The patient did well postoperatively and at follow-up remains tumor-free. Despite the uncommon occurrence of BCC in resection specimens for rhinophyma, we recommend that all specimens be reviewed by a pathologist. If BCC is detected, re-excision may be necessary and careful follow-up is mandatory. Larger studies would be needed to determine the correlation between the 2 conditions.

Topics: Aged; Carcinoma, Basal Cell; Cell Transformation, Neoplastic; Humans; Male; Nose; Nose Deformities, Acquired; Nose Neoplasms; Precancerous Conditions; Rhinophyma; Skin Neoplasms; Treatment Outcome

Bilevel undermining above and below the transverse nasalis muscle in the construction of a myocutaneous island pedicle flap produces a bilateral or unilateral muscular sling with exceptional vascular supply for reconstruction of defects on the distal nose. We present further modification of the single-sling myocutaneous island pedicle flap that expands its application to a wide variety of nasal defects and further defines its usefulness in nasal reconstruction.. A series of 61 consecutive myocutaneous island pedicle flap reconstructions performed after Mohs surgery between March 2005 and July 2006 are presented. Flap modifications are presented, and advantages and limitations are discussed.. Flap modifications introduce additional reach and rotational mobility to the flap that permit extension of the flap to defects on the nasal tip and distal ala.. Modifications of the bilevel approach to the single-sling nasalis myocutaneous island pedicle flap further define its practicality in nasal reconstruction and expand its application to a variety of nasal defects.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Aged; Carcinoma, Basal Cell; Female; Humans; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Lentigo maligna (LM) is an in situ variant of cutaneous melanoma, which usually occurs in sun-damaged skin. Surgical treatment of LM is often difficult and not well accepted by patients, as lesions are usually quite large and located on the face. Imiquimod 5% cream is a local immune response modifier that has been used off-label to treat LM. The authors report of 2 female patients with LM on the nose (aged 39 and 48 years) treated with imiquimod 5% cream applied 5 times a week for a total duration of 4 months. Videodermatoscopy, a noninvasive diagnostic technique, was used to address the diagnosis and to monitor treatment response with imiquimod therapy and during follow-up. At the end of the treatment period, the lesions had cleared in both patients, with no evident remnants confirmed by videodermatoscopy. The patients refused to undergo a control biopsy, but complied for a 30-month followed-up period which revealed no evident changes. The authors' experience, in agreement with other clinical reports and open trials, suggests that topical imiquimod is a valuable treatment option capable of leading LM to clinical clearance.

Topics: Adult; Aminoquinolines; Antineoplastic Agents; Dermoscopy; Female; Humans; Hutchinson's Melanotic Freckle; Imiquimod; Middle Aged; Nose; Skin; Skin Neoplasms

The reconstitution of a nasal alar rim and lobule defect represent a difficult challenge in consideration of his situation, anatomy and function. This article describes the technique and the interest of the nasolabial flap when used to cover the entire alar subunit.. We present 7 cases of alar rim and lobule defect after skin cancer excision. In the series, there are two full-thickness with lining defect. The patients were reconstructed with a superiorly based nasolabial flap, according to the subunit principle as introduced by Burget. A free cartilage graft was used to restore structural support with marginal skin flaps were turned over for intranasal lining when necessary.. The cosmetic and functional outcomes of each repair were judged from good to excellent by patients and surgeons. No case of flap infection or necrosis occurred.. The superiorly based nasolabial flap, describe by Burget, provides an excellent choice for cosmetic and functional reconstruction of the nasal alar defect.

Topics: Aged; Aged, 80 and over; Humans; Middle Aged; Nose; Nose Neoplasms; Patient Satisfaction; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Topics: Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms

Myopericytoma is a rare, recently described tumor demonstrating a hemangiopericytoma-like vascular pattern. We present two cases of myopericytoma associated with trauma: a 64-year-old man who developed several nodules on his nose four months after sustaining multiple abrasions to his forehead and nose, and a 72-year-old woman with a solitary growth in the alveolar ridge of unknown duration. Biopsy specimens of the lesions in both cases demonstrated a striking concentric perivascular proliferation of bland spindle-shaped pericytic cells characteristic of myopericytoma. Despite sharing morphologic features with angioleiomyoma, myofibroma and glomus tumor, myopericytoma is thought to represent a distinct perivascular myoid neoplasm of skin and soft tissues. The tumor is characterized by a radial and perivascular arrangement of ovoid, spindled to round neoplastic cells that are immunoreactive to alpha-smooth muscle actin, often for h-caldesmon as well as smooth muscle myosin-heavy chain, and usually negative for desmin antibodies. Most cases of myopericytoma are benign, however, local recurrence and malignancy have recently been reported, Myopericytoma can be multifocal involving a single or multiple anatomic regions, and tends to occur in dermal and superficial soft tissues of adults primarily on the extremities. Our cases are unusual examples of myopericytoma manifesting as multiple nodules on the nose, and a solitary growth on the buccal mucosa after trauma.

Topics: Actins; Aged; Biomarkers, Tumor; Calcium-Binding Proteins; Calponins; Female; Hemangiopericytoma; Humans; Male; Microfilament Proteins; Middle Aged; Mouth Mucosa; Myosin Heavy Chains; Nose; Skin Neoplasms; Soft Tissue Neoplasms; Treatment Outcome; Wounds and Injuries

First described by Texier in 1994, the mediodorsal transposition flap of the nose is an island flap. The paramedian dorsal arteries (anastomosed to the interdomal plexus) ensured the axial vascularisation in SMAS plane. The authors will discuss their personal approach to the surgical procedure for the improvement of final result, with four clinical cases. This flap can be used for aesthetic unit reconstruction of cutaneous or mucosal different alar defect (partial or complete, full-thickness or not). This reliable flap represents an alternative technique of composed grafts, of different nasolabial flaps, and of forehead flap.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

We present our experience in the reconstruction of full-thickness losses of the substance of the nose using a forehead flap and a composite graft (taken from the anterior surface of the concha and adequately shaped) as both support and endonasal lining. This technique has never been described for the reconstruction of large full-thickness losses of the substance of the nose. The donor site of the composite graft in the concha is repaired by a Masson retroauricular flap.. This technique was used on 14 patients (age range, 52-92 years) after full-thickness excision of tumors of the distal third of the nose. Follow-up was from 1 to 4 years. All the composite grafts were revascularized.. The results obtained were stable over time, and rhinoscopy, carried out 6 months after the operation, confirmed a homogeneous aspect and a perfect integration of the graft in the residual mucosa.. The use of a composite graft for internal lining and a forehead flap for external skin allowed is to obtain good results with minimal retraction. This technique is simple, fast and almost free of side effects.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Ear Cartilage; Female; Humans; Male; Middle Aged; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Suture Techniques; Treatment Outcome

Heterologous differentiation is exceedingly rare in melanoma. Only four cases of melanoma demonstrating exclusive cartilaginous differentiation have been documented, all having occurred on the lower extremity. We report a chondroid melanoma involving the nasal skin and presenting clinically as a basal cell carcinoma. Both Melan-A and microphthalmia transcription factor protein immunoperoxidase stains were positive in our case, demonstrating the potential utility of these two stains in chondroid melanoma. We also provide a succinct review of the literature on this rare melanoma variant.

Topics: Carcinoma, Basal Cell; Diagnosis, Differential; Female; Humans; Melanoma; Middle Aged; Nose; Skin Neoplasms

Amelanotic melanomas are well-known to mimic other dermatologic lesions and often result in delayed diagnosis and treatment. We report a case of an unusual presentation of amelanotic melanoma with an appearance similar to rhinophyma.

Topics: Aged; Diagnosis, Differential; Humans; Male; Melanoma, Amelanotic; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Patients with advanced skin cancer present a unique challenge to neurosurgeons. Treatment involves aggressive surgical intervention and lengthy reconstructive procedures with considerable morbidity to obtain adequate and safe oncological margins. We reviewed our experience with BioGlue Surgical Adhesive, a protein-based adhesive, as an adjunct in free tissue transfer procedures to prevent CSF leakage and seroma formation.. Between January 2000 and June 2004, 11 patients ranging in age from 32 to 87 years presented with advanced skin cancer tumors in the head and neck. Pathology included squamous (7) and basal (3) cell carcinoma and malignant schwannoma (1). Of the 11 patients, 8 had undergone previous surgery and/or radiation therapy. All were treated with a combination of craniotomy, skull base, and craniofacial approaches with reconstruction of the large defects using muscular or myocutaneous free flaps in a single operation. Fat, muscle, and a 1-mm epidural layer of BioGlue were used to seal the dural sutures and to obliterate any potential seroma-forming dead space.. A total of 6 patients underwent craniofacial resection with orbital exenteration and partial rhinectomy, whereas the remaining 5 underwent frontal, parietal, and/or occipital craniotomies. All patients required dural repair. Three patients required additional brain resection because of tumor infiltration. No patient developed a CSF leak or seroma. There were no adverse events related to the use of BioGlue. Three patients died of medical complications (pulmonary embolism, myocardial infarction, late-onset myelodysplasia). The remaining patients are alive, and our follow-up (range, 9-58 months) has revealed no recurrence or distal metastasis.. Advanced skin cancer tumors in the head and neck region are associated with complex and disfiguring surgical procedures with increased morbidity. We demonstrate that an adjunctive use of a sufficiently strong tissue adhesive can yield acceptable outcomes and minimize comorbidity in this challenging patient population.

Topics: Adult; Aged; Aged, 80 and over; Brain; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Craniotomy; Dura Mater; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Neurilemmoma; Neurosurgical Procedures; Nose; Orbit; Plastic Surgery Procedures; Postoperative Complications; Proteins; Skin Neoplasms; Tissue Adhesives

Squamous cell carcinoma of the skin (SCCS) is rarely encountered by medical oncologists owing to success of local therapies. When advanced SCCS requires systemic palliation, treatment with conventional chemotherapy, such as cisplatin, is often precluded by a patient's age or medical comorbidities. Cetuximab is a human and mouse chimeric antibody against epidermal growth factor receptor, a tyrosine kinase receptor richly expressed by SCCS cells, including lymph node metastases. This drug, approved for treatment of squamous cell carcinoma of the upper aerodigestive tract as well as colorectal cancer, is well tolerated. Toxic effects include acneiform rash and diarrhea. Preclinical data suggest that epidermal growth factor receptor is important in SCCS carcinogenesis.. Herein, we report 2 cases of elderly patients with extensive, in-transit recurrence of SCCS who have been treated with palliative cetuximab. The drug was well tolerated, with the exception of acneiform rash requiring dose reduction in 1 patient. Both patients had excellent responses to cetuximab: the first patient had complete response by week 16 of treatment and the second a near-complete response by week 12. In both cases, initial response to cetuximab was evident by week 4 of therapy.. To our knowledge, these are the first reported cases of cetuximab use in patients with SCCS. The encouraging responses justify the prospective study of cetuximab in SCCS.

Topics: Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Carcinoma, Squamous Cell; Cetuximab; Combined Modality Therapy; Epidermal Growth Factor; Face; Female; Humans; Male; Neoplasm Recurrence, Local; Nose; Scalp; Skin Neoplasms

Topics: Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Wounds and Injuries

Topics: Carcinoma, Squamous Cell; Female; Humans; Middle Aged; Mohs Surgery; Nose; Radiotherapy Dosage; Radiotherapy, Adjuvant; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Female; Humans; Nose; Skin Neoplasms; Surgical Flaps

Topics: Adult; Carcinoma; Carcinoma, Adenoid Cystic; Epidermal Cyst; Female; Forehead; Granular Cell Tumor; Heel; Humans; Male; Middle Aged; Mohs Surgery; Neoplasm Metastasis; Nose; Pilomatrixoma; Scalp; Skin Neoplasms

Topics: Aged; Carcinoma, Basal Cell; Diagnosis, Differential; Female; Humans; Nose; Skin Neoplasms; Surgical Flaps

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Forehead; Humans; Male; Nose; Postoperative Complications; Skin Neoplasms; Surgical Flaps

The treatment of lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging due to lesion location, size, patient age, and potential for recurrence and spread. The largest studies to date confirm that for melanocytic tumours, MMS provides high local control rates while minimizing tissue loss. Herein we report our local control rate for melanoma treated by MMS over a decade.. Charts were reviewed on all patients with melanocytic tumors treated by a single physician (JPA) using MMS over the time period of 1993-2002. Demographic, surgical and pathological details were recorded. Patients were followed for local, regional and distant recurrences.. The patient population was comprised of 199 patients with 202 melanomas. There were 69 invasive lesions, with a mean Breslow depth of 0.92 mm (0.2-3.6 mm). The mean number of levels required to clear the lesions was 2.7 (1-7), resulting in a mean defect size of 11.8 cm2 (0.9-70.7 cm2). Patients with LMM were significantly older (73.2 vs. 66.5 yrs, p = 0.012) and had larger defects after MMS (16.74 cm2 vs. 10.27 cm2) than patients with LM. At a mean follow-up of 29.8 months, there were no local recurrences, four regional recurrences, and two distant recurrences.. MMS is an effective modality for the clearance of melanocytic tumors.

Topics: Adult; Aged; Aged, 80 and over; Cheek; Female; Follow-Up Studies; Humans; Hutchinson's Melanotic Freckle; Male; Melanoma; Middle Aged; Mohs Surgery; Neoplasm Recurrence, Local; Nose; Skin Neoplasms; Treatment Outcome

To study 63 cases of nasal tumors treated by dermatologic surgery, and analyze their generality and characters.. The cases were analyzed with SPSS 10.0 and SAS6.12.. The average age of the patients was 46.92 +/- 18.63. The number of man was about equal to that of women. Most cases were basal cell carcinoma (42.9%). Nevus came second (38.1%). The other cases were benign tumors. The distribution of operational locations showed the character of nasal surgery. Operations of Alar occupied 52.4%, 22.2% were on the dorsal and 15.9% on the tip. Other locations occupied 9.5%. Cases of primary close occupied 69.8%. Cases applying complex close were 30.2%. Statistic analysis illustrated that primary close was different from complex close with distribution of operational locations. The area of defects between primary close and complex close was also different. At the same time, the differentiation of applying complex close was obvious between malignant tumors and benign tumors.. Skin cancers and benign tumors usually occur on the nose, so it is very important to master the techniques of plastic surgery to repair the defects of nose, besides removing tumors perfectly by the classical way of dermatologic surgery, Mohs Micrographic Surgery.

Topics: Adult; Aged; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nevus; Nose; Nose Neoplasms; Retrospective Studies; Skin Neoplasms; Treatment Outcome

There are only a few reports on the outcome with full-thickness skin grafts (FTSG) in defect reconstruction after Mohs micrographic surgery (MMS).. The objective was to evaluate the complications with FTSG in patients treated with MMS for cutaneous tumors.. This study is based on a prospective data collection of all patients in Australia treated with MMS and monitored by the Skin and Cancer Foundation, between 1993 and 2002. Primary outcome measures were FTSG recipient-site complications (partial/complete graft failure, graft infection, acute bleeding/hematoma, graft hypertrophy, and graft contracture).. The study group included 2,673 patients (50.2% men) with a mean age of 64+/-14 years. Most tumors were basal call carcinoma (90.9%) and were located on the nose (63.8%), periocular area (14.8%), or auricular area (8.1%). A total of 11.7% of cases had recipient-site complications (graft hypertrophy, 42.3%; partial graft failure, 27.2%; graft contraction, 15.3%). Only 45.2% of complicated cases required treatment.. Short-term recipient-site complications occurred in less than 12% of reconstructions with FTSG. Graft hypertrophy and partial graft failure accounted for most cases of complications. The authors have indicated no significant interest with commercial supporters.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Databases, Factual; Ear, External; Female; Forehead; Graft Survival; Humans; Male; Middle Aged; Mohs Surgery; Nose; Postoperative Complications; Prospective Studies; Skin Neoplasms; Skin Transplantation; Treatment Outcome

Topics: Adult; Carcinoma, Basal Cell; Diagnosis, Differential; Female; Humans; Mohs Surgery; Neoplasm Invasiveness; Nose; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy, Multiple; Skin Neoplasms; Surgical Flaps; Twins

The most common etiology of nasal defects that require reconstruction is basal cell carcinoma, as well as squamous cell carcinoma and melanoma. In reconstructing full-thickness ala nasi defects following excision of basal cell carcinomas, we present our technique of the nail enfolded local flaps which involves the harvesting of the nail plate and placing it to serve as a supporting component. In four patients, the nail plate grafts are inserted into various local flaps, and used for reconstruction of full-thickness ala nasi defects. Lining deficiencies of the alar lobule were resurfaced with skin grafts. None of the cases experienced skin graft loss or nail plate exposure. The nail graft prevented alar collapse by supporting the nasal airway. This technique discards the need for a second operation.

Topics: Aged; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Basal cell carcinoma (BCC) is the most common malignant tumour of the skin frequently located on the head and chiefly on the nose. Cryosurgery is one of the methods to treat BCC.. To determine the efficacy of cryosurgery of 17 BCC of the nose in terms of recurrence rates and cosmetic results.. 15 patients were included with a median age of 73 years and a photo type III or IV in 86% of cases. Mean size of tumours was 12 mm. Lesions were chiefly located on the alae nasi (70.5%). Complications were few and minor. After an average follow-up of 13.5 months, recurrence rate was about 5.8% (one case). Cosmetic results were good or excellent in 14 cases/17; only one patient had developed a notch of the nose.. Cryosurgery is a rapid, of a low cost technique and chiefly with good oncological and cosmetic results.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cryosurgery; Female; Humans; Male; Middle Aged; Nose; Retrospective Studies; Skin Neoplasms

Currently, various alloplastic materials are being used for reconstruction of three-dimensional structures, and high-density porous polyethylene is so far the best and the most commonly used material. Various indications for high-density porous polyethylene have been defined for closure of craniofacial defects, correction of congenital anomalies, and aesthetic augmentations. A common property of various studies published so far is that after being fixed to the bone or underlying structures, high-density porous polyethylene has been covered primarily or by skin flaps. For reconstruction of complex three-dimensional structures such as the ear and nose, the success of current methods is limited by the thinness and pliability of the skin flap. In this study, the authors' aim was to investigate the graftability of high-density porous polyethylene after prefabrication with an axial pedicle and to explore possible clinical applications in light of the new data obtained. In the experimental study, three-dimensional implants (rectangular prism) carved from high-density porous polyethylene were prefabricated using bilateral superficial epigastric arteries and veins of 25 New Zealand rabbits. After a waiting period of 2 to 6 weeks in five groups, control samples were obtained and the prefabricated implants that had been left in place were directly grafted. The results showed that high-density porous polyethylene was vascularized 75 percent after 4 weeks and 90 percent after 5 weeks, and 95 percent of the grafts had survived after 8 weeks. In the clinical study, three nose defects, three ear defects, and one hard palate defect in seven patients ranging in age from 21 to 72 years were reconstructed using the same method. High-density porous polyethylene has been prefabricated and directly grafted for the very first time on a clinical basis. No serious complications have been observed, except for minimal graft loss in two patients. It is obvious that full-thickness skin grafts that are thinner than flaps will adapt better to the fine details of high-density porous polyethylene and will highly increase the detail obtained in the reconstruction of three-dimensional defects.

Topics: Abdomen; Adult; Aged; Animals; Carcinoma, Basosquamous; Ear, External; Epigastric Arteries; Facial Injuries; Humans; Implants, Experimental; Lip; Middle Aged; Neovascularization, Physiologic; Nose; Nose Neoplasms; Palate, Hard; Polyethylene; Prostheses and Implants; Rabbits; Random Allocation; Skin Neoplasms; Soft Tissue Injuries; Wound Healing

There are few local nasal flap options for repair of proximal nasal defects. Absence of suitable donor sites and the large dimensions of the defects limit the use of local nasal flaps in this region. Regional paranasal flaps may not be suitable in these cases because of color, texture, and donor-site scars. The composite procerus muscle and nasal skin flap, which is vascularized by the dorsal nasal branch of the angular artery, can be a useful treatment modality for proximal nasal reconstruction. Seven patients were successfully treated using the composite nasal flaps. The maximal size of the defects was 2.4 cm. In one case, the composite nasal flap was readvanced to close a new defect resulting from reexcision. The composite nasal flap has several advantages in reconstruction of proximal nasal defects. Reconstruction is performed with the same tissue and the donor defect is closed primarily. The composite nasal flap can be moved in multiple directions and has great mobility to reach every point of the proximal part of the nose with axial blood supply. Furthermore, it can be easily readvanced without additional morbidity in case of reexcision.

Topics: Aged; Cadaver; Carcinoma, Basal Cell; Dissection; Esthetics; Female; Follow-Up Studies; Humans; Male; Middle Aged; Muscle, Skeletal; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Full-thickness skin grafting (FTSG) is an option for reconstruction of nasal defects.. To correlate the clinical outcome of FTSG on the nose with donor site, location of the defect, and defect size.. Patients with FTSG on the nose following Mohs' micrographic surgery were enrolled. Clinical and photographic assessments were performed.. There were 54 FTSGs; the mean age was 20.6 months, and the average size was 2.1 cm2. The clinical assessment score was significantly different across donor sites, with dog-ear skin providing the best results, followed, respectively, by conchal bowl, preauricular, postauricular, and inner arm skin (p = .006). The global clinical outcome determined from the clinical assessment score was good for inner arm skin and excellent for other sites. The photographic assessment score was not different among donor sites (p = .601). There was no correlation of location and size of the defect to the clinical outcome assessed clinically and photographically (p>.05).. All potential donor sites should be considered to select the donor site that best matches the defect.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Severity of Illness Index; Skin Neoplasms; Skin Transplantation; Texas; Treatment Outcome

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

The reconstruction of full-thickness nasal tip and alar defects is challenging owing to the distal nose's triple-layer structure: skin, cartilage, and mucosa.. In the reconstruction of wounds of the distal half of the nose involving the rim, the most important issue to be considered is to provide a good functional and an acceptable esthetic result. Various local and distant flaps have been described for this purpose. The nasolabial flap is one of the most frequently used flaps in reconstruction of small- to moderate-size distal nasal defects. Its reliable blood supply, minimal donor site morbidity, and excellent texture and color match are some of the advantages of this local flap.. In this study, superiorly based subcutaneous pedicled nasolabial flaps have been prefabricated with cartilage and skin grafts. This method has been used in 10 cases.. One patient had partial flap necrosis, and two patients experienced hyperpigmentation on the suture line. Scar revision was performed in one patient for hypertrophic scar tissue at the flap margins. No other complications were seen in the remaining patients. None of the patients experienced a skin graft loss or cartilage exposure.. The prefabricated nasolabial flap offers a superior esthetic and functional result and may be an appropriate reconstructive option in reconstruction of small- to moderate-size distal nasal defects.

Topics: Adolescent; Adult; Aged; Bites and Stings; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Nevus; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Topics: Aged; Carcinoma, Basal Cell; Female; Humans; Nose; Skin Neoplasms; Surgical Flaps

Full-thickness defects of the alar rim can be challenging to repair and often require the use of multistaged interpolated flaps. Alar notching is a known complication of these procedures even after cartilage batten grafts have been placed to support the alar framework. Standard techniques for repair of alar notching involve reinsertion of a cartilage graft, usually at the time of alar groove reconstruction 3 months postoperatively.. We present a technique to prevent alar notching associated with nasolabial interpolation flaps. If early notching is noted at the time of pedicle division, preemptive placement of a skin-fat composite graft can obviate the need for additional procedures.. A case report detailing the procedure and a review of the options for repair of alar notching are provided. RESULTS. Placement of a skin-fat composite graft harvested from the divided pedicle flap resulted in correction of alar notching.. This procedure is presented as an alternative to delayed cartilage grafting for repair of alar rim notching after placement of an interpolated pedicle flap. If notching is noted early, correction at the time of pedicle division allows for use of available tissue for composite grafting, avoidance of a delayed reconstructive procedure, and a good functional and cosmetic

Topics: Adipose Tissue; Aged; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

It is extremely rare for basal cell carcinoma (BCC) to metastasize, so it is often only simply excised. However, BCC may cause severe local tissue destruction, which often extends to surrounding muscle, cartilage, and bone; it is then termed "aggressive" BCC. We evaluated the safety margin and the reconstruction method in four cases of nasal BCC that were diagnosed as aggressive BCC histopathologically or by imaging, including magnetic resonance imaging (MRI) and computerized tomography (CT) and then treated by excision. The results showed that the larger the aggressive BCC was, the smaller the histopathological safety margins became. The lateral nasal region was classified into three regions, and individual reconstruction was performed according to anatomical unit, resulting in favorable outcomes. Nasal BCC should be closely examinated, it requires a careful treatment strategy similar to that for other malignant skin tumors.

Topics: Aged; Biopsy, Needle; Carcinoma, Basal Cell; Female; Follow-Up Studies; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Middle Aged; Mohs Surgery; Neoplasm Invasiveness; Neoplasm Staging; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome

Topics: Biopsy; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Humans; Hypopharyngeal Neoplasms; Lymph Nodes; Male; Middle Aged; Neck Dissection; Nose; Skin Neoplasms

Fibrous papule of the nose is a common benign lesion of dermal fibroblast lineage. Two unusual variants have been described, namely, fibrous papule with granular cells and fibrous papule with clear fibrocytes. We report a second case series (six cases) of clear cell fibrous papule to add to the first series of 9 cases. Clinical and histologic features in our cases are similar to those in the first series. All of our specimens were dome-shaped, 2- to 5-mm skin-colored to slightly erythematous papules on the faces of three male and three female adults ranging from 18 to 48 years of age. All but one lesion were on the nose. Clinical differential diagnoses included fibrous papule, verruca, basal cell carcinoma, and a variety of other neoplasms. Histologically, dermal aggregates of clear cells with finely granular to vacuolated cytoplasm, and centrally located nuclei, were found. Most specimens also contained ectatic capillaries, and all showed evidence of irritation or trauma. Periodic acid-Schiff stain was negative in all specimens to which it was applied (5/6). Neural, melanocytic, and epithelial origins were eliminated by negative staining with S-100, Mart-1, cytokeratins, epithelial membrane antigen, and carcinoembryonic antigen, performed on some of the specimens. A mesenchymal nature was confirmed in one specimen staining strongly positive for vimentin. Five of six cases stained positively for CD68, and all five cases studied were strongly and diffusely positive for NKI/C3. Factor XIIIa stain highlighted scattered dendritic cells within the lesion but was otherwise negative in all six cases studied. Recognition of this variant of fibrous papule is important to distinguish this benign lesion from other clear cell neoplasms.

Topics: Acanthoma; Adolescent; Adult; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Male; Middle Aged; Nose; Skin Diseases; Skin Neoplasms

Retroauricular tissue for reconstruction of external nasal defects was described by Washio. We describe our recent experiences in elderly patients, in whom the risk of reconstruction after excision of a malignant growth is high. We present seven reconstructions, six after excision of malignant disease, together with our ideas about how to maximise its possibilities.

Topics: Adult; Aged; Aged, 80 and over; Bites, Human; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps; Treatment Outcome; Wounds and Injuries

Topics: Anesthesia, Local; Anesthetics, Local; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Ear; Ear Neoplasms; Epinephrine; Female; Humans; Male; Nose; Skin Neoplasms

Local anesthetics supplemented with epinephrine are generally regarded as contraindicated for surgical procedures involving the fingers, toes, penis, outer ear and the tip of the nose [1], but epinephrine is essential if automated tumescence local anesthesia (Auto-TLA) is used.. Infiltration anesthesia supplemented with 1:200,000 epinephrine was used from 1985-1997 in our department, while Auto-TLA supplemented with 1:1.000,000 epinephrine was introduced in 1997 for all surgical procedures involving the ear or nose. During this period, 10,201 patients underwent surgery at these locations. In addition, dermal blood flow was analyzed by acral photoplethysmography (APPG) and laser Doppler flowmetry (LDF) in the right ear lobe of five normal volunteers and during epinephrine supplemented Auto-TLA.. Epinephrine-induced complications were not observed in a single patient. Cosmetic skin flap surgery was performed in 4,953 of these patients. Even in patients with extended surgical procedures that took up to one to two hours and that included extensive skin flaps or skin grafts, we observed no increase in complications when compared to procedures performed either under general anesthesia or local anesthesia without epinephrine supplementation. Measuring blood perfusion of the earlobe showed a 69% reduction of LDF and a 42% reduction of arterial inflow (APPG) immediately following anesthesia.. Epinephrine supplementation of local anesthetics does not block blood perfusion in the ear and did not induce organ, tissue or flap necrosis. Local anesthesia with epinephrine supplementation is therefore safe for acral areas such as the ear or nose. Despite the relatively small influence on blood perfusion, epinephrine supplementation results in a relatively bloodless operating field and longer effectiveness of local anesthesia. The relative absence of blood in the operating field of the ear and nose significantly reduces the duration of surgery and increases the healing rate, as less electrocautery is needed.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Ear; Epinephrine; Female; Humans; Laser-Doppler Flowmetry; Male; Middle Aged; Nose; Photoplethysmography; Skin Neoplasms; Surgical Flaps

Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the colour mismatch, it is not cosmetically identical to the face. The use of regional flaps such as the median forehead flaps are usually bulky, can not cover a wide range of facial reconstruction and usually require the donor area to be grafted. The naso-labial flaps are very useful and versatile local flaps, with robust vascularity that can be readily elevated without a delay. The flap can be superiorly based to reconstruct defects on the cheek, side wall or the dorsum of the nose, alae, collumula and the lower eye lid. Inferiorly based flaps can be used to reconstruct defects in the upper lip, anterior floor of the mouth and the lower lip. The flap can be turned over and used as a lining of the nose and the lip.. In the current study we present our experience with utilization of the nasolabial flaps in facial reconstruction. We evaluated the indications, flap designs, technique, and complications. We will also assess the final functional and aesthetic results.. The study included 20 patients (12 males and 8 females) presented at the surgical department, National Cancer Institute (NCI) Cairo University with skin cancer at different areas of the face. Preoperative assessment includes. Assessment of the stage of the disease, the flap design and patient general condition.. The mean age of the patients was 56.3 +/-6 years (range 16-62 years). Fifteen patients presented with basal cell carcinoma, 2 squamous cell carcinoma, one malignant melanoma, one keratoacanthoma, and one xeroderma pigmentosa. Nasal defects constituted 75% of cases, the rest were lower eye lid (2), one upper lip and one oral commisure beside a case of cheek reconstruction. There was no major complication; only one patient suffered a reactionary hemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most of the patients (80%), only 4 patients required revision of the scar at the donor site. The overall aesthetic results were very satisfactory in the majority of patients (16), and satisfactory in 2 cases. Only 2 patients were not satisfied by the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem.. The nasolabial flap is a versatile, simple, easy to harvest local flap that can cover a variety of defects in the face. It is ideally suitable for covering small and moderate sized defects in the eye lid, cheek, nose, the anterior floor of the mouth and the lip.

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Abnormalities, Multiple; Adult; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Ichthyosis; Male; Nose; Skin Neoplasms

Topics: Adenoma, Sweat Gland; Aged; Aged, 80 and over; Diagnosis, Differential; Humans; Male; Nose; Skin Neoplasms

Mohs surgeons are occasionally confronted by challenging pathology ideally requiring the advice of a dermatopathologist. The Internet transmission of digital images of the pathology (telepathology) allows for such opinions to be easily and rapidly obtained.. The objective was to obtain images utilizing a digital camera focused directly through one microscope eyepiece with subsequent e-mail to a pathologist for an immediate opinion.. The particular area of interest on the slide is selected. The lens of the digital camera is placed directly on one eyepiece of the microscope and using the zoom and autofocus options of the camera a sharp image is obtained. The camera flash must be disabled. The images are immediately downloaded to computer and e-mailed to the pathologist for an opinion.. Three case reports illustrate that the pathologist is able to offer suggestions on a diagnosis with a high degree of confidence using the e-mailed images.. Digital camera technology now allows for images to be taken directly through an eyepiece of the microscope. These images can be almost instantaneously e-mailed to a pathologist anywhere in the world for an immediate opinion. The technique provides for greater surety where doubt exists about the pathology during Mohs surgery.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Diagnosis, Differential; Ear, External; Humans; Image Processing, Computer-Assisted; Internet; Lip; Male; Middle Aged; Mohs Surgery; Nose; Skin Neoplasms; Telepathology

Topics: Female; Forehead; Humans; Mohs Surgery; Neoplasm Recurrence, Local; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Treatment Outcome

Some authors have used sebaceous epithelioma as a synonym for basal cell carcinoma (BCC) with sebaceous differentiation. However, our review of the literature revealed that definite cases of BCC with sebaceous differentiation that provide adequate clinical and histopathologic information are scarce. We present the case of a 72-year-old woman with a pigmented nodular lesion on her right ala nasi region, clinically diagnosed as pigmented BCC. Histopathologically, this nodular lesion, which was completely excised, showed typical features of BCC. It was noteworthy that within one aggregation of the presented BCC, tiny and small duct-like structures lined by cornified layers with a crenulated inner surface were seen. Vacuolated cells were scattered within a few aggregations, and they had foamy, bubbly cytoplasm and starry nuclei. The vacuolated cells were immunohistochemically positive for epithelial membrane antigen (EMA). These histopathologic findings demonstrated unquestionable sebaceous differentiation in this BCC, namely BCC with sebaceous differentiation, which should be distinguishable from both sebaceoma and sebaceous carcinoma. The small duct-like structures lined by eosinophilic cuticle, indicating apocrine differentiation, were also observed in this BCC.

Topics: Adenocarcinoma, Sebaceous; Aged; Biomarkers, Tumor; Carcinoma, Basal Cell; Cell Transformation, Neoplastic; Disease-Free Survival; Female; Humans; Immunoenzyme Techniques; Nose; Skin Neoplasms; Vacuoles

The treatment of large, deep, postsurgical nasal tip defects presents a serious problem for skin surgeons and is generally dealt with by using complex flaps or skin grafts.. The objective was to present the retroangular flap, a procedure that has only recently been described in literature.. The retroangular flap technique is based on inverting the blood flow in the angular artery, a vessel that runs along the nasal groove just below the surface of the skin.. The retroangular flap is a single-step, easily performed, procedure that is usually carried out under local anesthesia.. This technique can be used for the treatment of nasal tip defects and is a useful resource for skin surgeons.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Male; Mohs Surgery; Nose; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Topics: Humans; Nose; Skin Neoplasms; Suture Techniques

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Angiosarcomas are rare, aggressive tumors of vascular origin. They occur most often in areas of long term sun exposed skin in the elderly, in long standing lymphoedema or after radiation therapy. The prognosis is poor, radical surgery required, in addition radiation or chemo-therapy are considered to be therapeutical options. We report on a male patient, 70 years old with a slightly bleeding blueish tumor encompassing the complete nose. This patient treated with several antibiotics while continuous growth led to the described course. After 4 months a biopsy was taken revealing an angiosarcoma of the nose. Subsequently the patient was referred to our department and due to staging results a surgical therapy (ablatio nasi) followed. The final histological diagnosis was a low grade angiosarcoma of the cutaneous and subcutaneous tissue of the nose without infiltration of bone or cartilage, confirmed by immunohistological staining. Angiosarcomas of the head and neck region are extremely rare. Especially only few cases of nasal angiosarcoma infiltrating the complete nose are described in literature. Prognosis, therapy and differential diagnosis have to be discussed.

Topics: Aged; Biopsy; Hemangiosarcoma; Humans; Male; Nose; Nose Neoplasms; Prognosis; Skin; Skin Neoplasms; Surgical Flaps

Retinoids have the capacity to accelerate the involution of multiple keratoacanthomas, including unusual variants such as keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque that may persist and be associated with progressive growth and provide difficulties in diagnosis and management.. We describe 3 patients who had unusual infiltrated and keratotic plaques affecting the lower legs or nasolabial area that persisted or recurred that may be related to this group of unusual keratoacanthomas. The 3 patients had differing clinical lesions that did not resemble classic keratoacanthomas, but were linked by their biopsy findings of hypertrophic lichen planus-like reaction and pseudoepitheliomatous hyperplasia with a prominent infundibulocystic component that progressed to multiple keratoacanthomas or infundibulocystic squamous cell carcinoma. Polymerase chain reaction analysis of biopsy material from 2 patients failed to detect human papillomavirus. All 3 presentations provided a therapeutic dilemma, but responded rapidly to acitretin treatment at a dosage of 10 to 25 mg daily, which was continued for 15 to 24 months.. These cases illustrate an unusual reaction pattern that is hypertrophic lichen planus-like but, instead of evolving to classic lichen planus, progresses to infundibulocystic hyperplasia and the development of multiple keratoacanthomas or infundibulocystic squamous cell carcinomas. Retinoids represent a therapeutic option for this difficult clinical problem and may obviate repeated and extensive surgery.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Hypertrophy; Keratoacanthoma; Lichen Planus; Lower Extremity; Male; Nose; Skin Neoplasms

Topics: Humans; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Optimal aesthetic reconstruction of cutaneous defects following excisional surgery is largely dependent on the availability of regional donor tissue that shares a likeness of the original tissue in color, texture, sebaceous quality, and thickness. The island pedicle flap is a useful tool in facial reconstruction because it minimizes regional anatomic distortion and optimizes tissue match.. The objective was to review four locations where the island pedicle flap is a well-suited closure tool.. We review flap planning and specific modifications of the island pedicle flap at four sites of closure, reinforcing its role as an important tool in facial reconstruction.. Through careful planning and implementation, the island pedicle flap may be used on the nasal tip, the nasal ala, the upper cheek, and the upper lip for closures with much success.. The island pedicle flap remains an important tool in the armamentarium for surgeons in the repair of facial defects.

Topics: Cheek; Humans; Lip; Nose; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Adipocytes; Biopsy, Needle; Carcinoma, Skin Appendage; Female; Follow-Up Studies; Humans; Immunohistochemistry; Middle Aged; Nose; Risk Assessment; Skin Neoplasms; Treatment Outcome

Many techniques have been described to restore through-and-through alar defects both for the vestibular lining and the lobular skin. This study aimed to present our results with medially based nasolabial turnover flaps in the reconstruction of alar defects.. Medially based nasolabial turnover flaps were used in 11 patients (3 females, 8 males; age range 27 to 65 years) who had through-and-through alar defects due to trauma (n=3) and carcinoma (3 squamous cell, 5 basal cell carcinoma) excisions. The mean follow-up period was 17 months (range 8 to 24 months).. Infection was encountered in only one patient and was successfully treated with antibiotic therapy. All the flaps survived and no recurrence occurred during the follow-up period. The patients were content with the outcome and, despite recommendations, were not willing to have a revision surgery. No problems were seen associated with nasal obstruction.. Despite the need for minor revisions, esthetic and functional results with medially based nasolabial turnover flaps were satisfactory from the patients' standpoint.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Rhinoplasty; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Microcystic adnexal carcinoma (MAC) is a rare, locally aggressive tumor. Treatment for this neoplasm typically requires extensive local excision leading to morbidity. Therefore, the temptation to use alternative treatment options remains high.. We report one case of a nasal dorsum MAC treated with external beam radiation secondary to the patient's poor health status and preference.. After initial dramatic clinical resolution, the tumor recurred in a clinically more extensive and histologically more aggressive form.. On the basis of this case and several detailed in the literature, we therefore hypothesize that radiation therapy is not only an ineffective treatment for MAC, but evidence exists that this modality may induce conversion to a histologically and clinically less favorable neoplasm.

Topics: Aged; Biopsy, Needle; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Immunohistochemistry; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Adnexal and Skin Appendage; Nose; Radiation Dosage; Risk Assessment; Skin Neoplasms; Treatment Outcome

A case of a feline Merkel cell tumour is described. An 8-year-old, female cat developed a round, alopecic, reddish mass on the nose. Wide excisional surgery was performed with cartilage resection. Histologically the mass was composed of solid islands of mostly basophilic densely packed cells with a scant cytoplasm, which was suggestive of a neuroendocrine origin. Results of immunohistochemical studies using antibodies against neurone-specific enolase, chromogranin, synaptophysin and pan-cytokeratin allowed classification of the lesion as a Merkel cell tumour. Ultrastructurally, dense core granules were identified in the cytoplasm. In a 2-year follow-up no relapses or metastases were observed. The clinical course recorded is in contrast with the malignant nature of a Merkel cell tumour recently described in a cat and of the human Merkel cell tumour, but is similar to the course of the canine Merkel cell tumour which is often benign. Early diagnosis along with the use of wide surgical excision might be considered an important factor in preventing relapse of this tumour.

Topics: Animals; Carcinoma, Merkel Cell; Cat Diseases; Cats; Diagnosis, Differential; Female; Immunohistochemistry; Nose; Skin Neoplasms

From October 1996 to January 2001, 20 patients (14 men and six women) ranging from 36 to 75 years old have been treated for their small skin defects of the nose by using the bilobed flap. These skin defects were located in 15 cases at the alar region and in five cases at the tip region. They were secondary to the resection of basal cell carcinoma in 17 cases and benign tumors in three cases. Their diameter ranged from 8 to 17 mm and in all these cases there was no involvement of the lining or cartilage. The design used for this bilobed flap was the Zitelli one, based on some mathematical principles; its base was medial or lateral depending on the site of the defect. With this method, the skin defects were reconstructed esthetically without any distortion of local anatomy of the nose with skin having the same color, texture and thickness. With an average of 28 month follow-up, all these reconstructions were stable with discreet scars and without the trapdoor phenomenon. No complications were reported. Esthetic reconstruction of such subunit nasal skin defects is easily done by this technique and is better than that obtained by the majority of others methods.

Topics: Adult; Aged; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Nose; Plastic Surgery Procedures; Retrospective Studies; Skin Neoplasms; Surgical Flaps; Treatment Outcome

The reconstruction of full-thickness alar wounds often requires multiple challenging surgical procedures. These procedures, although often functionally and aesthetically successful, are often staged, and they therefore introduce operative risks, significant investments of surgeon and patient time, and extraordinary costs.. A turnover nasolabial flap can offer a one-step repair of difficult full-thickness alar wounds. A thorough explanation of the flap's design and execution is presented. An understanding of these factors is required to achieve predictably reliable operative results.. A case report and review are given.. The turnover nasolabial flap can produce aesthetic and functional results that rival the most sophisticated pedicled flap reconstructions of the lateral ala.. In distinction to the multiple operative procedures required to replace the missing tissues of the complicated ala, this turnover flap offers a one-step elegant repair of the nose. The flap belongs in the repertoire of any dermatologic surgeon interested in facial reconstruction.

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Humans; Male; Mohs Surgery; Nose; Rhinoplasty; Skin Neoplasms; Surgical Flaps

Pleomorphic liposarcoma (PLPS) is a high-grade pleomorphic sarcoma, containing multivacuolated lipoblasts, which usually develops during late adult life. It usually occurs in the deep soft tissues and uncommonly arises in the subcutis, the dermis representing an exceedingly rare site of occurrence.. We describe a case of PLPS arising in the dorsal aspect of the nose of a 75-year-old woman. Preoperative duration was 9 months.. The lesion was intradermal well-circumscribed, dome-shaped, measuring 1.2 cm. It fulfilled the histologic criteria for inclusion in the PLPS category. The tumor cells focally expressed calretinin. A review of the literature yielded four cases documented, to which we add the present report. All the patients were adults with a mean age of 67 (range 39-95) years, and three of five cases arose on the scalp. Local recurrence occurred in one patient, but no distant metastases or disease-related deaths were observed.. PLPS very rarely arises in the dermis. In spite of high-grade morphology, the intradermal tumor shows a relatively favorable prognosis. Diagnostic consideration includes pleomorphic lipoma, clear cell atypical fibroxanthoma, balloon cell melanoma, and metastatic clear cell carcinoma of renal origin. Recognition of this distinctive and rare type of liposarcoma is essential to avoid under- or misdiagnosis and inappropriate treatment.

Topics: Aged; Biomarkers, Tumor; Calbindin 2; Dermis; Female; Humans; Ki-67 Antigen; Liposarcoma; Nose; S100 Calcium Binding Protein G; Skin Neoplasms; Treatment Outcome

We report the case of a 69-year-old man who had a persistent lesion develop on his nose during a 1-year period of time that was diagnosed as rhinophyma. Despite laser treatment the lesion continued to grow. Histopathology and immunohistochemical studies were consistent with cutaneous angiosarcoma. Rhinophyma-like features should be considered as an unusual clinical manifestation of cutaneous angiosarcoma.

Topics: Aged; Biopsy, Needle; Combined Modality Therapy; Diagnosis, Differential; Follow-Up Studies; Hemangiosarcoma; Humans; Immunohistochemistry; Male; Nose; Radiotherapy, Adjuvant; Rhinophyma; Risk Assessment; Skin Neoplasms; Surgical Procedures, Operative; Treatment Outcome

Topics: Adult; Carcinoma, Basal Cell; Humans; Male; Mohs Surgery; Nose; Nose Deformities, Acquired; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Humans; Male; Melanoma, Amelanotic; Middle Aged; Nose; Skin Neoplasms

Topical imiquimod is an immune response modifier FDA approved for the treatment of anogenital warts. Recent studies have reported its effectiveness in the treatment of some types of basal cell carcinomas. There have also been some case reports and case series reporting success treating of squamous cell carcinoma in situ with imiquimod. We report two patients with squamous cell carcinoma in situ and one with invasive squamous cell carcinoma treated with 5% imiquimod cream. Lesions were located on shin, posterior shoulder, and nasal tip. 5% imiquimod cream was applied at night for six weeks. Side effects included erythema and crusting in one patient. Biopsies taken four weeks after treatment revealed no residual squamous cell carcinoma in situ or squamous cell carcinoma. Topical 5% imiquimod cream is becoming established as a promising treatment for squamous cell carcinoma in situ. It also seems to be an alternative treatment for some cases of squamous cell carcinoma.

Topics: Administration, Cutaneous; Aged; Aminoquinolines; Antineoplastic Agents; Bowen's Disease; Female; Humans; Imiquimod; Leg; Male; Nose; Shoulder; Skin Neoplasms; Treatment Outcome

Topics: Humans; Nose; Plastic Surgery Procedures; Sensitivity and Specificity; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Treatment Outcome; Wound Healing

Malignancies in scars are generally known as Marjolin's ulcer. The majority of these arise from burn injuries. Although Marjolin's ulcer consists of all kinds of skin cancer, squamous cell carcinoma is the main cancer type reported in the literature. The pathogenesis of this tumor is due to chronic irritation of the effected area and mostly involves the extremities and scalp area. This report presents an unusually located and rare type of Marjolin's ulcer: on the nose and baso-squamotic in type. A 54-year-old man, 33 years after burn, presented with an unhealed ulcer on his nose which had been present for 2 years. The case was managed by tumor excision and a naso-labial transposition flap. To our knowledge, this is the first report of Marjolin's ulcer developing on post-burned skin of the nose.

Topics: Burns; Carcinoma, Basosquamous; Humans; Male; Middle Aged; Neoplasms, Post-Traumatic; Nose; Nose Neoplasms; Skin Neoplasms; Ulcer

Immediate reconstruction after removal of skin cancer by Mohs micrographic surgery (MMS) may not be feasible in patients unwilling or unable to undergo an extensive procedure. Human cadaveric allograft (HCA) may offer a useful alternative to granulation.. To examine the usefulness of HCA in resurfacing nasal defects after extirpation of basal cell carcinoma (BCC) by MMS.. Case histories of seven patients treated with HCA were reviewed with respect to primary skin cancer histology, defect size, medical status, healing time, and cosmesis.. Five of seven tumors were infiltrative BCCs. Defects ranged from 2.7 to 20 cm2. Average healing times for wounds with and without exposed cartilage were 42 and 35 days, respectively. There were no wound infections. Hypergranulation tissue was noted in three patients and had no effect on cosmesis, which was adequate in five patients and poor in two patients.. HCA may be a useful alternative to granulation following MMS for treatment of skin cancers involving the nose.

Topics: Aged; Aged, 80 and over; Cadaver; Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Postoperative Care; Skin Neoplasms; Skin Transplantation

Topics: Aged; Biopsy, Needle; Female; Follow-Up Studies; Hemangiosarcoma; Humans; Immunohistochemistry; Mohs Surgery; Nose; Skin Neoplasms

Multiple wound closure options exist for cutaneous defects of the nasal ala. The best option depends on the depth, size, and location of the defect.. To demonstrate a modification of the traditional rotation flap for closure of small alar defects.. The design and execution of the "spiral" flap for closure of a representative defect are described.. Immediate and delayed postoperative views demonstrate expected outcome.. The spiral flap modification of the rotation flap is a simple and elegant closure option for small nasal alar defects.

Topics: Humans; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

A study was undertaken to investigate the treatment of superficial squamous cell carcinoma of the nasal planum, pinna and eyelid in cats by photodynamic therapy, using topical 5-aminolaevulinic acid cream, with subsequent exposure to red light of wavelength 635 nm, supplied by a light-emitting diode source. A total of 13 squamous cell carcinomas were treated, including 10 nasal planum lesions, two pinnal lesions and one eyelid lesion. After a single treatment, complete responses were seen in nine out of 10 nasal planum lesions, one out of two pinnal lesions and the eyelid lesion. The overall complete response rate for lesions managed with a single photodynamic therapy treatment was 85 per cent. Seven of the 11 lesions (63.6 per cent) showing a complete response subsequently recurred; the time to recurrence ranged from 19 to 56 weeks (median 21 weeks, mean 26.7 weeks).

Topics: Administration, Topical; Aminolevulinic Acid; Animals; Carcinoma, Squamous Cell; Cat Diseases; Cats; Ear, External; Eyelid Neoplasms; Light; Neoplasm Recurrence, Local; Nose; Photochemotherapy; Photosensitizing Agents; Skin Neoplasms; Time Factors; Treatment Outcome

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Aminoquinolines; Antineoplastic Agents; Carcinoma in Situ; Carcinoma, Squamous Cell; Female; Humans; Imiquimod; Keratosis; Male; Middle Aged; Nose; Photosensitivity Disorders; Precancerous Conditions; Skin Neoplasms; Thorax

We report a rare hair follicle nevus that occurred in a three-month-old Japanese boy with mild frontonasal dysplasia. It had been present since birth. Histologically, numerous tiny vellus hair follicles were found within the dermis. The constituent cells of these follicles showed the features of follicular germ cells under the electron microscope. The fibroblasts around the follicles were active and merged with the colloid substance. Many myofibroblasts were found in a collagenous stroma in the atrophic lesion of the frontonasal dysplasia.

Topics: Diagnosis, Differential; Forehead; Hair Follicle; Humans; Infant; Male; Nevus; Nose; Skin Neoplasms

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Diagnosis, Differential; Female; Hidrocystoma; Humans; Melanoma; Nevus, Blue; Nose; Skin Neoplasms

A 28-year-old woman presented with a recurrent nodule on the lower margin of her left nostril after laser surgery. Histologically, the nodule had an indistinct margin and was composed of interlacing fascicles of plump, spindled or stellate tumor cells with mild cytologic atypia. The tumor cells were revealed to be myofibroblasts by positivity to smooth muscle actin and negativity to desmin. A diagnosis of low grade myofibroblastic sarcoma (LGMS) was made.

Topics: Actins; Adult; Diagnosis, Differential; Female; Humans; Neoplasms, Muscle Tissue; Nose; Recurrence; Skin Neoplasms

Topics: Aged; Aged, 80 and over; Carcinoma, Merkel Cell; Diagnosis, Differential; Erythema; Female; Humans; Nose; Skin Neoplasms

We describe a patient with a large nodular basal cell carcinoma (BCC), which was excised following apparent failure to respond to radiotherapy. Histological examination of the fully excised lesion demonstrated a solid mass of amyloid, which stained positively for cytokeratins, but there was no residual BCC.

Topics: Aged; Amyloidosis; Carcinoma, Basal Cell; Female; Humans; Nose; Radiation Tolerance; Skin Diseases; Skin Neoplasms; Treatment Failure

After studying this article, the participant should be able to: 1. Understand the epidemiology of skin cancer in a patient with preexisting skin cancer. 2. Understand the indications for the use of a nasolabial flap and nonanatomic alar strut graft. 3. Describe the blood supply to the nasolabial flap. The goals of reconstructing deformities of the face acquired secondary to skin tumors include optimizing donor-site aesthetics and reconstructing the area with similar types of tissue when possible. Multiple skin-cancer defects are often seen by the plastic surgeon and complicate the reconstruction, requiring more than one flap or skin graft. A case analysis of an innovative application of the nasolabial flap for reconstruction of a simultaneous medial cheek and alar-base nasal defect is presented. Concepts in nasal reconstruction are reviewed, and the authors' approach to alar reconstruction is presented.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Facial Neoplasms; Female; Humans; Nose; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Surgical Flaps

Topics: Aged; Diagnosis, Differential; Humans; Male; Nose; Rheumatoid Nodule; Skin Neoplasms

A seventeen-year-old Korean girl had a reddish-brown papular lesion on the nose. Histopathologically, it proved to be a "hyalinizing Spitz nevus" with the characteristic features of a discohesive growth pattern of nevus cells and hyalinized stroma. Immunohistochemical stains showed positive reactivity of nevus cells with S-100 protein and Vimentin and negative stainings with HMB45, CD68, CEA and low molecular weight cytokeratin. Hyalinizing Spitz nevus may represent a variant in the spectrum of Spitz nevus.

Topics: Adolescent; Facial Dermatoses; Female; Humans; Hyalin; Immunohistochemistry; Nevus, Epithelioid and Spindle Cell; Nose; Skin Neoplasms

The present case, a 75-year-old man with extranodal B-cell lymphoma showed facial hemiplegia, paresthesia and cutaneous manifestations. He was initially diagnosed as having a facial paralysis of unknown etiology. One month after the original diagnosis, erythematous indurated plaques developed on his left cheek and nose. A skin biopsy from the plaque on his cheek showed dense infiltrates of large lymphocytes with irregularly shaped nuclei and prominent nucleoli in the dermis and subcutaneous tissue. The lymphocytes were positive for L26 and CD79a. A diagnosis of diffuse large B-cell lymphoma was made. A muscle biopsy from facial muscle in the area of the erythematous plaque showed massive destruction of the muscle tissues by the lymphomatous infiltrates. Furthermore, electrodiagnostic study showed peripheral cranial nerve palsies, involving the left facial and trigeminal nerves. We conclude that diffuse large B-cell lymphoma may develop symptoms such as facial hemiplegia and paresthesia prior to cutaneous manifestations. Diffuse large B-cell lymphoma must be considered as one of the important causes of palsies of cranial nerves at the peripheral level.

Topics: Aged; Biopsy; Cheek; Cranial Nerve Neoplasms; Diagnosis, Differential; Facial Muscles; Facial Nerve; Facial Paralysis; Humans; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Magnetic Resonance Imaging; Male; Muscle Neoplasms; Nose; Skin Neoplasms; Trigeminal Nerve

Deep nasal defects of the dorsum, sidewall, and ala can be challenging to repair.. The article describes our experience with a muscle hinge transposition flap with overlying local full-thickness skin grafting for repair of deep nasal defects in a single-stage procedure.. A muscle hinge transposition flap with overlying local full-thickness skin grafting was used immediately after Mohs micrographic surgery to repair 12 deep nasal defects of the dorsum, sidewall, alar lobule, and supratip.. No cases of infection, flap, or graft necrosis occurred in our series. Cosmetic and functional outcomes were judged from good to excellent by patient and surgeon. To enhance the cosmetic outcome, 5 patients underwent spot dermabrasion within 2 months of repair.. For properly selected small to medium-sized deep nasal defects (1-2 cm) that lack a sufficiently loose adjacent tissue reservoir for a single-stage local flap, a muscle hinge transposition flap with local full-thickness skin grafting can provide consistently satisfying aesthetic and functional results.

Topics: Carcinoma, Basal Cell; Humans; Mohs Surgery; Muscle, Skeletal; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation

Non-ocular melanoma is considered to be a rare neoplasm in cats; however, more than 150 cases have been reported in the literature since 1961. The objective of this study was to characterise this tumour better by evaluating case outcome and survival data for cats with melanoma and to compare clinical and histopathological findings with those of previous reports. Twenty-three feline non-ocular melanomas were identified, the most common locations being the nose, digit and pinna. Cats with digital melanomas had survival rates similar to their canine counterparts. Histological assignation of benignity, malignancy or junctional activity was not found to be an accurate predictor of clinical behaviour. Melanoma should be considered as a differential diagnosis for cats presenting with pigmented or non-pigmented masses and histopathology is essential for definitive diagnosis, as other tumours may clinically appear quite similar. Regular follow-up examinations are recommended indefinitely for benign or malignant feline melanomas.

Topics: Animals; Cat Diseases; Cats; Diagnosis, Differential; Ear; Female; Male; Melanoma; Nose; Records; Retrospective Studies; Skin Neoplasms; Toes

Lymphoepithelioma-like carcinoma (LELC) is prototypically represented by "undifferentiated" nasopharyngeal carcinoma, but it has also been described in many other anatomic locations, including the skin. In the last of these sites, primary LELC has been assumed in the past to show dermal adnexal differentiation.. The authors present a case wherein LELC of the skin (LELCS) instead appeared to be a morphologic manifestation of squamous carcinoma of the skin surface, as supported by the results of immunohistology and in situ hybridization.. Like other examples of LELCS, it showed no evidence of integration of the Epstein-Barr viral genome, and its behavior was indolent.. The heterogeneous nature of LELC as seen in different body sites is reviewed in this report, resulting in the conclusion that this tumor probably represents a morphologic pattern rather than a distinct clinicopathologic entity.

Topics: Aged; Aged, 80 and over; Antigens, CD; Biopsy; Carcinoma, Squamous Cell; Female; Humans; Nose; Nose Neoplasms; Skin Neoplasms

We report a patient with massive facial sarcoidosis. While skin involvement is a common manifestation of sarcoidosis, it is unusual to see it in the dramatic form of cutaneous tumors with mutilation of the central face. There are few reports of tumoral cutaneous sarcoidosis like that of our patient.

Topics: Adult; Facial Dermatoses; Female; Humans; Nose; Orbital Neoplasms; Sarcoidosis; Skin Neoplasms

The pathologic findings of a sclerotic fibroma of the skin may resemble those of other benign cutaneous lesions. In this report, the sequential pathologic changes of a recurrent sclerotic fibroma of the skin during a period of 7 years are documented. As the lesion became older, there was not only a decrease in cellularity, but also a progressive organization of the collagen bundles toward a "plywood-like" appearance.

Topics: Adult; Female; Fibroma; Humans; Immunohistochemistry; Neoplasm Recurrence, Local; Nose; Skin; Skin Neoplasms; Vimentin

The plastic qualities and vascular reliability of the frontal flap have been widely used for reconstruction of facial tissue. We revised the files of 105 patients who had undergone surgical repair of facial tissue loss with frontal flaps. The epidemiology, etiology of the repaired tissue loss and indications for frontal flap as well as the various techniques were analyzed: 66.7% of the patients were over 60 years of age; 74% had ambulatory surgical repair; 54.4% of the repaired tissue losses were situated in the nasal region; 80% of the losses were due to tumoral formations. The median flap was the most widely used (23.2%).

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Carcinoma, Basal Cell; Child; Child, Preschool; Esthetics; Face; Facial Injuries; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Precancerous Conditions; Retrospective Studies; Sensation; Skin Neoplasms; Skin Transplantation; Surgical Flaps

Repair of soft tissue loss of the medial canthal area is usually accomplished by using skin grafts or frontal flaps based on the glabellar vessels. However, skin grafts can provoke scar tissue contracture, or skin color chromatic changes (hypopigmentation or hyperpigmentation). On the other hand, frontal flaps are sometimes thicker than normal skin and lead to unsatisfactory aesthetic results. To avoid these disadvantages, the authors designed an alternative method for reconstruction of defects of the medical canthal area. The authors suggest using a myocutaneous flap (V-Y design) from the nasal bridge to repair soft tissue defects no larger than 2 cm in diameter (surface < 4 cm2) in the medial canthal area. The pedicle of this flap is based on supratrochlear and dorsal nasal vessels. This technique has proved safe and reliable and has led to good functional and cosmetic results.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Eye Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Retrospective Studies; Skin Neoplasms; Surgical Flaps; Treatment Outcome

Topics: Carcinoma, Squamous Cell; Female; Humans; Karyotyping; Middle Aged; Nose; Osteoarthropathy, Primary Hypertrophic; Skin Neoplasms

Malignant neoplasms of the nasal cavity and paranasal sinuses are uncommon. Choriocarcinoma is a highly malignant germ cell tumour occurring in the reproductive organs. Metastasis may be principally by the lymphatic route as in other germ cell tumours but choriocarcinoma is also known to spread haematogenously. We present a rare case of metastatic choriocarcinoma to the nasal cavity from testicular teratoma presenting with intractable epistaxis in a 32-year-old Caucasian male, who ultimately succumbed to this disease.

Topics: Adult; Choriocarcinoma; Epistaxis; Fatal Outcome; Humans; Male; Nose; Nose Neoplasms; Paranasal Sinuses; Skin Neoplasms; Testicular Neoplasms; Tomography, X-Ray Computed

Mohs' micrographic surgery (MMS) is the recommended treatment for large basal cell carcinomas (BCCs) of the nose. This 5-year follow-up study attempts to evaluate whether curettage-cryosurgery (CC) could be an alternative therapy in a country where optimal resources for MMS are lacking. All patients with a primary nasal or perinasal BCC, 10 mm or larger in diameter, were assessed at a skin tumour clinic. Sixty-one BCCs of non-morphoeiform type were treated with CC. Most of the tumour was removed by careful curettage with different sized curettes. The tumour area was then frozen with liquid nitrogen in a double freeze-thaw cycle. Fifty patients were followed for at least 5 years with only one recurrence. The cosmetic result was good or acceptable in all patients. A thorough curettage followed by cryosurgery could be a safe and inexpensive alternative therapy even for large primary non-morphoeiform BCCs of the nose.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cryosurgery; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mohs Surgery; Nose; Skin Neoplasms

The nose is particularly vulnerable to cutaneous malignancies, making it the most common location for presentation. Recurrence of these cutaneous lesions is not uncommon, often compromising the timing of nasal restoration. It is the purpose of this report to reexamine the safety of primary nasal reconstruction in selected patients.. Seventy-one patients who underwent nasal reconstruction at The University of Texas M. D. Anderson Cancer Center between 1987 and 1995 were retrospectively reviewed. There were 35 men and 36 women with an average age of 60 years. All nasal reconstructions were performed for defects secondary to malignancies. Basal cell carcinoma was the most common lesion (n = 49), followed by squamous cell carcinoma (n = 10) and melanoma (n = 7), with five additional variable malignancies. The most common location of the cutaneous lesions was the nasal dorsum, and the forehead flap was the most common adjacent tissue used for reconstruction. Immediate reconstruction was performed for 42 of the basal cell carcinomas, 6 of the squamous cell carcinomas, 6 melanomas, and 3 other lesions. Delayed restoration was performed for 7 basal cell carcinomas, 4 squamous cell carcinomas, 1 melanoma, and 2 additional lesions. The average time between surgical extirpation and the start of nasal reconstruction was 8.2 months for basal cell carcinoma, 29 months for squamous cell carcinoma, and 10 months for melanoma.. Twenty-six recurrent lesions were identified at an average of 36 months after extirpation. Despite these numbers, only three recurred after nasal reconstruction at our institution. Follow-up averaged 41 months, with none less than 1 year. Seventy patients are still alive with no evidence of disease.. Primary reconstruction is safe in selected patients. Surgical delay in reconstruction should be considered if margins are questionable, the pathology is determined to be aggressive, if there is perineural or deep bony invasion, or if postoperative radiotherapy is to be initiated. Nasal reconstruction ultimately is based upon a complex series of issues but can be performed with few complications in an effort to restore self-image.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Disease-Free Survival; Evaluation Studies as Topic; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Nose; Prognosis; Retrospective Studies; Risk Factors; Skin Neoplasms; Surgery, Plastic; Surgical Flaps; Survival Rate

Subcutaneously pedicled island flaps (SPIF) are very mobile local flaps bringing into the surgical defect skin of similar texture and color to that of the recipient site. SPIF flaps are eminently simple to create: an island of skin is incised until the fatty tissue is visualized and the flap connections to surrounding tissue are carefully disconnected without damaging the nutrient vessels. The viability of such flaps is excellent. If appropriately performed, side effects such as pincushioning are rare.

Topics: Esthetics; Face; Forehead; Humans; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Topics: Carcinoma; Fatal Outcome; Humans; Lung Neoplasms; Male; Middle Aged; Nose; Paraneoplastic Syndromes; Skin Neoplasms

A deep defect of the nasal alar rim or lobule may represent a unique and difficult challenge because of the lax free margin and structural support supplied by the alar rim and lobule. Traditional closure strategies, including granulation, full thickness skin grafting, or nasolabial transposition flaps may result in unsatisfactory cosmetic and functional outcomes.. This article describes our experience with the staged cheek-to-nose interpolation flap for repairing deep skin cancer excision defects of the nasal alar rim and lobule.. The staged cheek-to-nose interpolation flap was used immediately after Mohs micrographic surgery to repair 18 deep nasal alar rim/lobule defects. In 13 patients, a free cartilage graft was used to restore structural support.. The cosmetic and functional outcomes of each repair were judged from good to excellent by patient and surgeon. No cases of infection or flap necrosis occurred. To enhance the cosmetic outcome, three patients underwent spot dermabrasion within 2 months after flap detachment.. The staged cheek-to-nose interpolation flap, with or without free cartilage grafts, consistently provides good to excellent cosmetic and functional outcomes when performed on properly selected deep nasal alar rim/lobule defects.

Topics: Cartilage; Cheek; Collateral Circulation; Dermabrasion; Esthetics; Follow-Up Studies; Graft Survival; Granulation Tissue; Humans; Lip; Mohs Surgery; Necrosis; Nose; Nose Neoplasms; Patient Satisfaction; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Surgical Wound Infection; Treatment Outcome

Skin cancer involving the nasal tip is fairly common. The repair of these nasal tip defects is often a challenging opportunity. The current range of reconstructive techniques include partial closure and second intention healing to skin grafts and midline forehead flaps.. Here we present an interesting method of nasal tip repair harvesting a rotation flap that uses adjacent skin from lateral and upper bridge of nose.. Using three case studies examples of the rotation flap are demonstrated to reconstruct the nasal tip defects following Mohs surgery for skin cancer.. For medium size defects of up to 1 cm in diameter, rotation flaps offer an alternative surgical one-stage method of reconstruction of the nasal tip in selected cases.. Satisfactory results can often be achieved with a modest amount of planning, intra-, and postoperative care. Rotation flaps possess a circular configuration that allow recapitulation of the natural creases and contours of nasal tip anatomy resulting in aesthetic repairs.

Topics: Humans; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Topics: Dermabrasion; Female; Forehead; Humans; Middle Aged; Nose; Nose Deformities, Acquired; Nose Neoplasms; Skin Neoplasms; Surgical Flaps; Suture Techniques; Sutures

A large cutaneous horn was excised from the left side of the nose and cheek of a 68-year-old woman. Reconstruction was performed with a split-thickness skin graft. Histologically the lesion represented squamous cell carcinoma. The nature of malignant degeneration in cutaneous horns is discussed.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Keratosis; Nose; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation

We studied 722 reexcision scars of benign and malignant lesions (except melanocytic lesions) excised over a 24-month period. The formalin-fixed, paraffin-embedded tissue sections were examined histologically and immunohistochemically. The histological features of melanocytic hyperplasia were present in 59 cases (8%), 56 from the sun-exposed skin of the face and neck and three from the trunk [p < 0.00001]. The most common sites were the nose and lower eyelids, but the forehead was also frequently involved. Of the 59 patients, 41 were women (p < 0.0001). Basal cell carcinoma was the most frequent original lesion in both sexes (80%). No melanocytic hyperplasia was found in 663 cases (298 on the trunk and extremities and 365 on the head and neck). We have seen this reaction pattern following reexcision of melanocytic lesions as well. Thus, interpreting reexcision margins when lentigo maligna or similar lesions are reexcised may be fraught with difficulty. It is important for pathologists and dermatopathologists to recognize this phenomenon because histologically the presence of increased numbers of large melanocytes could be misinterpreted as melanoma in situ.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Child; Cicatrix; Eyelids; Face; Female; Forehead; Humans; Hutchinson's Melanotic Freckle; Hyperplasia; Immunohistochemistry; Male; Melanocytes; Melanoma; Middle Aged; Neck; Nose; Sex Factors; Skin Neoplasms; Sunlight

Reconstruction of the lower third of the nose can be challenging. Maintaining the nasal subunit symmetry and providing good tissue match with regard to color, sebaceous quality, and thickness is essential. For extensive defects in this area, paramedian forehead flaps are often considered.. Our purpose was to develop the technique of preparing and executing the cheek island pedicle flap, as well as to define the limitations and "pitfalls" of the flap.. The cheek island pedicle flap is described.. The cheek island pedicle flap can provide excellent cosmetic results in reconstructing defects of the lower third of the nose. The flap dynamics are predictable, and anticipated complications are described.. The cheek island pedicle flap provides an excellent alternative to the paramedian forehead flap for reconstruction of extensive defects of the lower third of the nose.

Topics: Aged; Carcinoma, Basal Cell; Cartilage; Cheek; Contracture; Esthetics; Female; Graft Survival; Humans; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps; Wound Healing

Full-thickness defects of the nasal alar rim are relatively common following Mohs micrographic surgery for the treatment of long-standing or recurrent skin tumors. Composite grafts provide an excellent cosmetic and functional alternative for the repair of such defects.. A useful technique of auricular composite graft placement for reconstruction of full-thickness nasal alar rim defects is described.. The cartilaginous portion of the graft is extended beyond the borders of the soft tissue defect so that two cartilaginous pegs frame the lateral aspects of the graft. These pegs are then inserted into pockets prepared within the alar tissue of both sides of the defect, such that the graft interlocks with its recipient bed. A series of diagrams as well as a set of photographs from a representative case are provided, along with accompanying commentary, so as to enable the surgeon to incorporate this technique easily into his/her practice.. The interlocking auricular composite graft technique permits increased graft stability, with decreased shearing forces of the graft over its recipient bed, and a larger surface area for revascularization, resulting in an increased probability of graft survival. This technique provides an elegant single stage alternative to current reconstructive techniques for full-thickness nasal alar rim defects measuring less than 1.5 cm in diameter.

Topics: Bandages; Cartilage; Ear, External; Esthetics; Graft Survival; Humans; Mohs Surgery; Nose; Nose Neoplasms; Skin Neoplasms; Skin Transplantation; Suture Techniques

Partial or total lower lid reconstruction implies the repair of three layers: the skin, the tarsus, and the conjunctiva. The method of reconstruction must, therefore, aim at three objectives: ensuring the stability of the lid by repairing the tarsoconjunctival layer, achieving an aesthetic result with the repair of the skin, and taking into consideration the primary role of the upper lid in the ocular protective system. We recommend a musculocutaneous flap, taken from the upper lid, with a single lateral or medial pedicle combined with a chondromucosal alar graft. During the last 10 years, 41 patients were operated on with malignant skin tumors requiring marginal, partial, and total lower lid reconstruction. The results were quite satisfactory from a functional and aesthetic point of view. We noticed two cases of partial flap necrosis and two cases of ectropion needing revision. We believe that the procedure described can be a tool in the armamentarium of the plastic surgeon involved in the field of the orbitopalpebral area.

Topics: Eyelid Neoplasms; Eyelids; Humans; Nose; Reoperation; Skin Neoplasms; Surgical Flaps

The subcutaneous pedicle hinge flap provides excellent reconstruction of deep defects of the lateral base and caudal sidewall of the nose that extend into the cheek. The indications, flap design, and operative technique are described.

Topics: Cheek; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

A new method for correction of asymmetric alae is presented. Asymmetric alae frequently follow nasal, columellar, and alar reconstruction, and the resulting distortion can pose a reconstructive dilemma. Correction of these deformities can require complex composite grafting or tissue rearrangement procedures. By transposing the columella, we have equalized asymmetric nostrils without introducing new tissue to the region. Although not appropriate to all types of alar discrepancy, this novel method, where applicable, is safe, reliable, and does not produce significant visible scarring or donor site morbidity.

Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Female; Humans; Middle Aged; Nose; Skin Neoplasms; Surgery, Plastic

An increased use of multiple flaps applied to single reconstructive problems is encouraged. Removal of a basal cell carcinoma involving the medial canthus and adjacent lateral nasal root skin resulted in significant defect. When a glabellar "fan" flap failed to provide adequate tissue for canthal reconstruction without undue distortion, a preplanned medial cheek rotation flap followed sequentially in the repair process. The basic principles of an O-to-Z flap reconstruction were therefore fulfilled by conjoining two different flap design applications.

Topics: Carcinoma, Basal Cell; Cheek; Humans; Nose; Skin Neoplasms; Surgical Flaps

The nasolabial flap has frequently been used in many ways to repair the nostril. It has also been the subject of numerous criticisms, essentially related to the poor quality of the results obtained. However, the authors consider that it has an important place in the treatment of partial transfixing defects of the nostril. The nasolabial flap must be performed according to certain precise rules: strictly nasal superior pedicle, defatting of the entire flap, rotation of the flap around the external extremity of the pedicle, plication of the flap and modelling to recreate the alar margin and to reconstitute the lining. Several clinical examples illustrate this use of the flap and allow the indications to be defined.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

This study is an analysis of anatomic basis and clinical application of retrograde axial skin flap. The arterial supply of retrograde axial skin flap was classified into three types: (1) Arcuate artery; (2) Circular artery; (3) Arterial anastomosis branch. The venous return of retrograde axial skin flap was also divided into three types: (1) No venous valve; (2) Weak venous valve; (3) Venous anastomosis branch. 35 cases of soft tissue defect were repaired by retrograde axial skin flaps. The sizes of the flaps ranged from 4 x 2 cm to 18 x 7 cm. All flaps survived with satisfactory results. Advantages and disadvantages, the donor area, the selection of vascular pedicle, and the precautions in the preparation of this flap were discussed.

Topics: Adult; Cicatrix; Female; Humans; Male; Middle Aged; Nevus; Nose; Skin; Skin Neoplasms; Surgical Flaps

Topics: Angiofibroma; Coloring Agents; Humans; Laser Therapy; Nose; Skin Neoplasms

Anecdotal reports and clinical observations have suggested that the response of port-wine stains to treatment with the pulsed dye laser is variable and dependent on the anatomical location of the lesion. To investigate anatomical variation in response to treatment, a retrospective study of 259 adults and children with port-wine stains of the head and neck treated with the pulsed dye laser was undertaken. Evaluation was performed by comparing simultaneously projected pretreatment and completion-treatment photographs. Anatomical differences in response were evaluated in three ways: (1) by anatomical subdivision of the head and neck into regions, (2) by dermatomal distribution, and (3) by response for midline lesions. The head and neck was subdivided into eight anatomical regions, which were independently evaluated for response. In addition, response for individual dermatomes and for midline lesions was evaluated. Response in all cases was assessed by determining the percentage of lightening from 0% to 100% (where 100% represents complete response) at the completion of treatment. Response grades were also assigned, using grades poor (0% to 25% lightening), fair (26% to 50% lightening), good (51% to 75% lightening), or excellent (76% to 100% lightening).. One hundred thirty-seven adults and 122 children were included in the study. Evaluation by subdivision of the head and neck into regions revealed that in adults and children the centrofacial regions (medial aspect of the cheek, upper cutaneous lip, and nose) responded less favorably than the other grouped regions (periorbital, forehead/temple, lateral aspect of the cheek, neck, and chin); the centrofacial regions showed a good response (mean lightening, 70.7%) while the other grouped regions of the head and neck showed an excellent response (mean lightening, 82.3%). Evaluation by dermatomal distribution revealed that dermatome V2 showed a good response (mean lightening of 73.8%), while combined dermatomes V1, V3, and C2/C3 showed an excellent response (mean lightening of 82.4%). Evaluation of midline lesions revealed excellent responses in adults and children (mean lightening, 92.4%).. Port-wine stains of the head and neck in adults and children demonstrate differences in response to treatment with the pulsed dye laser according to their anatomical location. Centrofacial lesions and lesions involving dermatome V2 in adults and children respond less favorably than lesions located elsewhere on the head and neck. Midline lesions respond very favorably in adults and children.

Topics: Adolescent; Adult; Aged; Cheek; Child; Child, Preschool; Face; Facial Neoplasms; Female; Hemangioma; Humans; Infant; Laser Coagulation; Lip; Male; Middle Aged; Nose; Orbit; Photography; Rhodamines; Skin Neoplasms; Skin Pigmentation; Treatment Outcome; Trigeminal Nerve

Topics: Aged; Carcinoma, Basal Cell; Female; Home Nursing; Humans; Male; Middle Aged; Nose; Respiratory Insufficiency; Respiratory Protective Devices; Skin Neoplasms; Sleep Apnea Syndromes

A forehead neurovascular island flap has twice been used for reconstruction of minor full thickness nasal defects caused by surgical removal of malignant tumours. The flap was raised one month before transposition, and a split thickness skin graft was applied to the inner surface of the galea of the flap. The periosteum of the forehead was also grafted, thus repairing the donor site before the flap was removed. The flap is based on the supraorbital artery, which was dissected to its origin at the incisura or supraorbital foramen. The advantages are those of a small flap with external as well as internal lining and with preserved sensibility.

Topics: Adult; Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Forehead; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

Topics: Adenoma, Sweat Gland; Female; Humans; Middle Aged; Nose; Skin Neoplasms

Microcystic adnexal carcinoma is an unusual, locally aggressive tumor that recently has been recognized as a distinct clinicopathologic entity. It typically occurs on the face of young or middle-aged women and often requires extensive surgical excision to gain local control. A case involving the upper lip and columella of a young woman is described and the available literature reviewed. The difficult reconstructive challenge this lesion usually presents is illustrated in this patient who required upper lip and complete columellar reconstruction.

Topics: Adult; Carcinoma; Facial Neoplasms; Female; Humans; Lip; Mohs Surgery; Nose; Skin Neoplasms; Surgical Flaps

Topics: Carcinoma, Basal Cell; Cryosurgery; Curettage; Ear, External; Evaluation Studies as Topic; Facial Neoplasms; Humans; Nose; Skin Neoplasms

A retrospective study of 643 cutaneous horns examined in our department between 1970 and 1989 revealed that 38.9% were derived from malignant or premalignant epidermal lesions, and 61.1% from benign lesions. Four main features were associated with premalignant or malignant histopathological change at the base of a cutaneous horn (base pathology). These were: (i) age--the mean age of the patients whose cutaneous horns showed premalignant or malignant base pathology was 8.9 years greater than the mean age of the patients where base pathology was benign (P less than 0.0005); (ii) sex--males were more likely to develop a cutaneous horn with (pre)malignant base pathology (P less than 0.001); (iii) site--over 70% of all (pre)malignant lesions were found on the nose, pinnae, backs of hands, scalp, forearms and the face; a cutaneous horn found at these sites was 2.1 times more likely to have derived from a (pre)malignant base than from any other part of the body (P less than 0.0001); (iv) geometry of the lesion--lesions with a wide base or a low height-to-base ratio were significantly more likely to show (pre)malignant base pathology. Of those solar keratoses giving rise to cutaneous horns, 8.9% also showed histological evidence of change to squamous cell carcinoma (SCC); this figure was not significantly different from the 6.2% of solar keratoses without horns that showed SCC change during the same period (1970-89).

Topics: Age Factors; Carcinoma, Squamous Cell; Ear, External; Face; Female; Forearm; Hand; Humans; Keratosis; Male; Microcomputers; Nose; Precancerous Conditions; Retrospective Studies; Risk Factors; Scalp; Sex Factors; Skin; Skin Diseases; Skin Neoplasms

Defects of the nose after oncological operations were classified on the basis of clinical material and indications to primary and delayed rhinoplasty were pointed out. The problems of choosing the method of plasty were considered depending on the localization of the defect, its size and previous treatment. The advantages of arterialized flaps and free revascularized transplants were discussed. Examples were given.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Nose; Rhinoplasty; Skin Neoplasms

The author presented the treatment of a more advanced nasal skin cancer in 79 years old woman with immediate reconstructive surgery.

Topics: Aged; Female; Humans; Nose; Skin Neoplasms; Surgery, Plastic

Primary and recurrent cutaneous carcinomas of the nose and the adjacent perinasal tissues often invade more deeply than cutaneous carcinomas in other areas. The operative defect may be large. The physician who has to close these defects is faced with a challenging problem that requires an appreciation of facial anatomy and function. There is often more than one option in the repair of these defects. Important concepts in the management of lateral nose and perinasal surgical defects are discussed.

Topics: Humans; Microsurgery; Nose; Nose Neoplasms; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Surgery, Plastic

The nasolabial flap has for many years been an excellent choice for reconstruction of the nasal ala following excision of skin cancer or trauma. When done as a single-stage procedure the result can be a nonaesthetic appearing mass. We propose an initial excision with flap inset and a second procedure for debulking and contouring the alar groove to complete reconstruction of the aesthetic unit. Representative cases are presented.

Topics: Carcinoma, Basal Cell; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Reoperation; Skin Neoplasms; Surgical Flaps

A case of sebaceous trichofolliculoma on the nose of a 42 year old man, present at the birth, is reported. The histology was typical, with a cavity formed by the skin of the nose having numerous well developed sebaceous glands along with vellus and terminal hairs.

Topics: Adult; Humans; Male; Nose; Sebaceous Glands; Skin Neoplasms

From 1956 to 1978, 646 patients were treated with radiotherapy for carcinoma of the nose (350 patients, 54 percent), eyelids (159 patients, 25 percent), pinna (93 patients, 14 percent), and skin adjacent to the lip (44 patients, 7 percent). The histologic distribution was 72 percent basal cell carcinoma, 18 percent squamous cell carcinoma, and 10 percent mixed basal and squamous cell features. Tumors less than 2 cm in diameter were found in 602 patients (93 percent), whereas 44 patients (7 percent) had larger tumors. Tumor involvement of cartilage and bone was seen in 23 patients at the time of diagnosis. The 5, 10, and 20 year control rates were 99 percent, 98 percent, and 98 percent, respectively, for 502 tumors less than 2 cm in diameter. This compared favorably with control rates of 92 percent at 5 years and 79 percent at 10 years for tumors from 2 to 5 cm in diameter and 60 percent at 5 years and 53 percent at 8 years for 12 patients with massive tumors (p less than 0.0001). The histologic characteristics of the lesion had a strong influence on tumor control (p less than 0.02). Of the patients with cartilage or bone invasion, tumor was controlled in 19 (83 percent). Of these 19 patients, 11 had no evidence of disease for 3 years or more. Of all 646 patients treated, failure was seen in 60 (9 percent). It correlated well with the size of the lesion, being 7 percent for tumors of less than 2 cm and 50 percent for tumors of greater than 5 cm. Of the 60 patients in whom treatment failed, 48 (80 percent) had prior definitive therapy. Radiotherapy was an efficient modality to control operative failures; however, it was not as efficient at control in patients in whom previous radiotherapy failed. Operation was the treatment of choice to salvage patients in whom radiotherapy failed. Of the patients in whom retreatment failed, 10 were known to have died from skin cancer, and an additional 6 patients were presumed to have died from the cancer. This study has demonstrated a good control rate and good cosmetic results for small tumors of the eyelids, pinna, and nose. In addition, a good control rate was obtained in patients with cartilage and bone involvement. Treatment of massive tumors should involve planned operative resection with adjuvant radiotherapy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Carcinoma, Basosquamous; Carcinoma, Squamous Cell; Ear, External; Eyelids; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Radiotherapy Dosage; Skin Neoplasms

Topics: Animals; Carcinoma, Squamous Cell; Elastic Tissue; Horse Diseases; Horses; Nose; Skin; Skin Diseases; Skin Neoplasms; Sunlight

Topics: Carcinoma, Basal Cell; Ear, External; Humans; Laser Therapy; Nose; Skin Neoplasms

During a period of over 20 years, 896 patients were treated with radiation in Wadsworth Medical Center, Los Angeles, for carcinoma of the lip and selected sites of skin of the head and neck. Basal cell carcinoma (BCC) was found in 467 (52%) patients, squamous cell carcinoma (SCC) in 362 (40%), and the remaining 67 (8%) had tumors with mixed basal and squamous cell features. BCC was the most common tumor (72%) among the 646 skin cancer patients while SCC predominated (99%) among the 250 lip cancer patients. Tumor control correlated well with the size of the lesion, p less than 0.0001. Histology of the lesion also had a significant (p = 0.021) influence on the tumor control rate, which was the highest among the BCC patients when compared with SCC or mixed cell patients. This study has again demonstrated the effectiveness of radiotherapy in controlling small and intermediate size epithelial tumors of the skin and lip. Additionally, irradiation, if administered properly, results in excellent cosmesis and a low incidence of treatment complications. Severe complications of radiotherapy reported in the literature took place at the beginning of this century and are no longer pertinent in the practice of modern radiation oncology. Larger lesions remain a challenge to radiation or surgical dermato-oncologists. A lack of tumor control in such lesions frequently results in a death of patient.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Lip Neoplasms; Middle Aged; Nose; Radiotherapy; Skin Neoplasms

Trichoepithelioma histologically resembles basal cell epithelioma, but only rarely do the two lesions coexist. The case reported here documents a patient with hereditary trichoepithelioma who presented with a basal cell epithelioma of the medial canthus invading the lower eyelid. The clinical and histologic features of both entities will be discussed, as well as the possibility of malignant transformation of a trichoepithelioma to a basal cell epithelioma.

Topics: Adult; Carcinoma, Basal Cell; Female; Head and Neck Neoplasms; Humans; Necrosis; Nose; Skin Neoplasms; Surgery, Plastic

A huge nodular and ulcerous basal cell carcinoma in a 78-year-old male patient slowly developed over a period of 10 years. Although the tumor had existed such a long time, there was no indication for destructive deep growth or formation of metastases.

Topics: Aged; Carcinoma, Basal Cell; Humans; Male; Nose; Palliative Care; Skin Neoplasms

Topics: Aged; Carcinoma, Squamous Cell; Cheek; Female; Forehead; Humans; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Flaps

We report on a 85-year-old woman suffering from a fibrofolliculoma at the root of her nose. This benign tumor is very uncommon, and its histological findings are little known. Pathogenetically we suspect a self-contained interaction between the epithelial and mesodermal component of the pilary complex.

Topics: Aged; Connective Tissue; Female; Fibroma; Glycosaminoglycans; Humans; Nose; Skin; Skin Neoplasms

The technique of facial reconstruction used by the plastic team at the Cancer Center of the University of Brussels are presented. Free grafts are seldom performed because they often lead to disfigurement. An appropriate evaluation of the margins of resection is obtained during the operation by multiple frozen sections, and reconstruction is achieved by local flaps when possible. It is considered that a normal appearance is of extreme importance for old patients suffering from facial cancer, and that the aim of surgery is not only complete eradication of the lesion but also careful reconstruction of the removed structures by simple and safe procedures. The selected techniques are presented for each region of the face.

Topics: Aged; Carcinoma; Cheek; Ear Neoplasms; Ear, External; Eyelids; Face; Facial Neoplasms; Forehead; Humans; Lip; Middle Aged; Neoplasm Recurrence, Local; Nose; Scalp; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

Twenty-five tumours sampled from various sites on sheep were implanted subcutaneously into nude mice. Of these, 10 were successfully transplanted and serially passaged. An association was found between the tumour growth site on the sheep and its acceptance as a xenograft, with those derived from the skin of the nose being the most successful. Both growth pattern (expansive or invasive) and the histological appearance of the xenografts were similar to that observed in the sheep although faster growth rates were observed after the tumour was serially passaged in the nude mouse.

Topics: Animals; Carcinoma, Squamous Cell; Cell Division; Ear, External; Female; Mice; Mice, Nude; Neoplasm Transplantation; Neoplasms, Experimental; Nose; Sheep; Sheep Diseases; Skin Neoplasms; Transplantation, Heterologous; Vulva

Dermatologic epithelioma of the nose is usually a basocellular and more rarely a spinocellular epithelioma. Small tumors less than 5 mm in diameter can be treated by electrocoagulation, whereas those over 1 cm should be treated by surgery or physical methods. Of a total of 144 cases of epithelioma operated upon, 10% were reconstructed by a flap. Increasing use is being made of local anesthesia with subsequent reduced hospital stay. The quality of the carcinologic results, similar to that of physical methods, and the excellent healing obtained, particularly in elderly patients, are arguments in favor of extensive surgery for epitheliomas in this region. The quality of the resection is difficult to evaluate, unless results of a fresh specimen examination are available. When not possible then it is preferable to await results of histology to show limits of excision before performing an autoplasty with flaps.

Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Humans; Nose; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

Granulocytic sarcoma of the skin is only rarely the initial manifestation of acute granulocytic leukemia. In the absence of systemic signs and symptoms of leukemia, routine histologic examination of granulocytic sarcoma may result in misdiagnosis. A case of granulocytic sarcoma preceding overt leukemia is reported in which the biopsy specimen was initially interpreted as granuloma faciale.

Topics: Aged; Diagnosis, Differential; Granuloma; Humans; Leukemia, Myeloid, Acute; Male; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Abnormalities, Multiple; Bone Transplantation; Cranial Sutures; Female; Frontal Bone; Humans; Infant; Male; Nose; Osteotomy; Radiography; Scalp; Skin Neoplasms; Skull; Surgery, Plastic

Topics: Child; Female; Humans; Neurofibromatosis 1; Nose; Skin Neoplasms; Spherocytosis, Hereditary

The excision of small cutaneous malignancies of the nose frequently results in defects that are appropriate for closure with a nasolabial flap. However, in the older male patient with thick nasal skin, the flap frequently undergoes the trapdoor phenomenon, producing a bulky, unsightly mass. This problem can be corrected, however, by excision of the redundant skin and subcutaneous tissue, leaving a graftable base that can be resurfaced with a full-thickness postauricular skin graft. This method of revision appears superior to just elevating and thinning the flap.

Topics: Adult; Aged; Carcinoma, Basal Cell; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Retrospective Studies; Skin Neoplasms; Surgical Flaps

Neuroendocrine (Merkel cell) carcinoma of the skin is usually a tumor found in elderly individuals. Microscopically, the tumor is a small cell carcinoma that involves primarily the dermis. The dominant ultrastructural features are the presence of short cell processes containing small, dense-core, membrane-bound granules. The tumor is often locally aggressive, has the potential to metastasize to lymph nodes, and eventually causes death. The authors report a case of such a neoplasm that affected a 24-year-old man with congenital ectodermal dysplasia. It was associated with a concurrent basal cell carcinoma.

Topics: Adenocarcinoma; Adult; Humans; Male; Nose; Skin Neoplasms

Topics: Carcinoma; Chin; Facial Neoplasms; Humans; Nose; Skin Neoplasms; Surgery, Plastic; Surgical Flaps

Topics: Aged; Carcinoma, Basal Cell; Humans; Methods; Nose; Nose Neoplasms; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Adult; Female; Humans; Lymphoma, Non-Hodgkin; Nose; Nose Neoplasms; Skin; Skin Neoplasms

A patient developed a cutaneous deposit of leukaemic cells within a squamous cell carcinoma as the first presentation of acute myeloblastic leukaemia.

Topics: Aged; Carcinoma, Squamous Cell; Facial Neoplasms; Humans; Leukemia, Myeloid, Acute; Male; Neoplasms, Multiple Primary; Nose; Skin; Skin Neoplasms

Topics: Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Skin Neoplasms

Since the beginning of 1974 70 basal cell carcinomas of the face were treated by cryosurgery at the ENT clinic in Göttingen. The cryosurgical removal of basalomas on a cartilagenous base (nose, auricle) avoids hospitalization of the patient and relieves the surgeon of a time-consuming plastic operation. Scar formation after cryonecrosis is, in general, excellent and cosmetically unobtrusive. All patients must undergo strict follow-up examinations since for the surgeon there is no histologic safeguarding by an "excision into healthy tissue".

Topics: Carcinoma, Basal Cell; Cryosurgery; Ear, External; Humans; Male; Middle Aged; Nose; Skin Neoplasms

Topics: Adolescent; Age Factors; Carcinoma, Squamous Cell; Humans; Male; Nose; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

Rhabdomyosarcomas are malignant tumors, and especially occur in childhood. In adults they are extremely rare. A pleomorphe rhabdomyosarcoma of the skin, localized on the nose of an 85-year old female patient, is reported. After surgical removal the defect was reconstructed with a full skin graft. The four histologic types of rhabdomyosarcoma (pleomorphic, alveolair, embryonal, botryoid) are discussed.

Topics: Aged; Female; Humans; Nose; Rhabdomyosarcoma; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Carcinoma, Squamous Cell; Humans; Intubation; Intubation, Gastrointestinal; Intubation, Intratracheal; Jaw Neoplasms; Mandible; Methods; Mouth Floor; Mouth Neoplasms; Nose; Skin Neoplasms; Tongue; Tracheotomy

Topics: Child; Child, Preschool; Congenital Abnormalities; Dermoid Cyst; Disorders of Sex Development; Ear, External; Eyebrows; Facial Neoplasms; Female; Fistula; Hemangioma; Hemangioma, Cavernous; Humans; Infant; Male; Neck; Nevus, Pigmented; Nose; Nose Neoplasms; Penis; Skin Neoplasms

Papilomatosis Carcinoides, presents clinical and histological characteristics that may be authentically described as a transition state between the benign papillomatous proliferations and spindle cell carcinoma. It involves a series of clinical conditions, that are described with different names that correspond to the condyloma accuminatum gigantum. [Buschke and Lowenstein) wartic carcinoma [Ackerman], Papillomatosis oral florid [Rock and Fisher], carcinomatoid [Gilbert] profuse conjuntival papillomatosis [Bazex], etc. These latter only refer to partial localizations or a special clinical form. That is why we believe the denonmination Papillomatosis Carcinoides, is preferable, which is its cutaneous, mucose or semimucose forms involves all of them. The treatments applied to the 18 cases presented have been very diverse: they vary from the elimination of the lesions by the application of topical podophylin to large surgical ablations. But most of them showed a regression or cure of their lesions by citostatics [methotrexate] not prevent the proliferative advance of the lessions. These therapeutic data can also contribute to its nosologic classification. In some cases they have an evolutive character with slow progression for years, still being curable with podophylin and in others that due to their chronic evolution with added supuration, and complications of the general health, make surgery necessary. In most cases, the antimetabolities are the therapy of choice the radiations seem inoperative. It may be noted that tumoral papillomatous lesions produced by virus, exist in veterinatian pathology (fibropapillomatosis in the bovine genitals, equine sarcoid, papilomatosis of goats, monkeys, etc.). Noteworthy are those of the oral mucosa of rabbits which are white greyish sesiles or pedunculated small nodules localized mostly on the inferior surface of tongue with a similar histology to the papilomatosis carcinoides. These observations would suggest a viral ethiology, even though all the efforts to isolate the virus of the lesions gave negative results. Our attention is drawn to case n. degrees 14. That began as a simple plantar wart. There have also been numerous cases in which from the beginning they were simple condylomas accuminatum, caused without any doubt by a virus. The carcinoid papillomatosis could be related to the spindle-cell carcinoma that developed in the areas of chronic infection with herpetic virus n. degrees 2, where the virus can be isolate

Topics: Aged; Carcinoma, Papillary; Child, Preschool; Diagnosis, Differential; Epithelium; Female; Fingers; Humans; Leg; Male; Middle Aged; Mouth Mucosa; Mouth Neoplasms; Nose; Penile Neoplasms; Skin Neoplasms

Topics: Aged; Biopsy; Carcinoma, Transitional Cell; Cystitis; Cystoscopy; Humans; Male; Neoplasm Metastasis; Nose; Nose Neoplasms; Prostate; Prostatic Neoplasms; Skin; Skin Neoplasms

Topics: Cerebrospinal Fluid Rhinorrhea; Cryosurgery; Epistaxis; Fractures, Bone; Histiocytoma, Benign Fibrous; Humans; Mucous Membrane; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Nose Diseases; Nose Neoplasms; Rhinitis; Rhinoplasty; Rosacea; Skin Neoplasms

Topics: Candidiasis, Oral; Chordoma; Darier Disease; Dermatitis; Diagnosis, Differential; Erythema; Gingival Neoplasms; Herpes Simplex; Humans; Hypersensitivity; Nose; Palatal Neoplasms; Papilloma; Precancerous Conditions; Purpura; Skin Diseases; Skin Neoplasms; Syndrome

Topics: Adult; Asian People; Cicatrix; Cleft Lip; Dermoid Cyst; Female; Glioma; Head; Humans; Hypertrophy; Japan; Male; Middle Aged; Nevus, Pigmented; Nose; Nose Deformities, Acquired; Nose Neoplasms; Pigmentation Disorders; Postoperative Care; Postoperative Complications; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

The plastic surgeon is not a miracle worker, as so many of his patients believe. Nevertheless, he can do much to minimize the functional and cosmetic effect of many congenital deformities. If a moral can be drawn from this article it must be that the plastic surgeon should be given an early opportunity to see and assess the patients described here, if only to ease the anxiety in the minds of their parents by appropriate reassurance and discussion.

Topics: Arteriovenous Malformations; Breast; Congenital Abnormalities; Dermoid Cyst; Ear; Female; Fingers; Humans; Hypospadias; Leg; Lymphangioma; Lymphedema; Male; Nevus; Nevus, Pigmented; Nose; Skin Neoplasms; Surgery, Plastic; Vagina; Wrist

Topics: Aged; Amyloid; Amyloidosis; Carcinoma, Basal Cell; Collagen; Epithelial Cells; Female; Fibroblasts; Head; Humans; Male; Mast Cells; Microscopy, Electron; Microtomy; Middle Aged; Nose; Skin Neoplasms; Staining and Labeling

Topics: Adult; Aged; Carcinoma, Basal Cell; Child; Female; Hemangioma; Humans; Male; Methods; Middle Aged; Nevus; Nose; Radiodermatitis; Rhinoplasty; Skin; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Adenocarcinoma; Adult; Age Factors; Aged; Back; Brain Neoplasms; Breast Neoplasms; Carcinoma, Basal Cell; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Squamous Cell; Cecum; Colonic Neoplasms; Female; Gallbladder Neoplasms; Glioblastoma; Humans; Intestinal Neoplasms; Male; Middle Aged; Neoplasms; Nose; Oligodendroglioma; Skin Neoplasms; Stomach Neoplasms; Uterine Neoplasms; Vitiligo

Topics: Adult; Aged; Carcinoma, Basal Cell; Cautery; Chlorides; Eyebrows; Female; Humans; Male; Microsurgery; Middle Aged; Neoplasm Recurrence, Local; Nose; Prognosis; Skin Neoplasms; Zinc

Topics: Adolescent; Adult; Aged; Biopsy; Connective Tissue; Female; Histocytochemistry; Humans; Male; Middle Aged; Nevus; Nevus, Pigmented; Nose; Nose Neoplasms; Periodic Acid; Skin; Skin Neoplasms; Staining and Labeling

Topics: Electroencephalography; Epilepsy, Temporal Lobe; Female; Head and Neck Neoplasms; Humans; Infant; Nevus, Pigmented; Nose; Scalp; Sebaceous Glands; Skin Neoplasms

Topics: Adult; Aged; Cheek; Face; Female; Humans; Lip; Male; Methods; Middle Aged; Neck; Nose; Skin Neoplasms; Skin Transplantation; Surgery, Plastic

Topics: Adult; Aged; Arm; Blister; Carcinoma, Squamous Cell; Cheek; Diagnosis, Differential; Eosinophils; Epidermal Cyst; Epithelium; Facial Dermatoses; Female; Granulation Tissue; Humans; Keratosis; Male; Middle Aged; Nose; Skin; Skin Neoplasms

Topics: Adult; Aged; Carcinoma, Basal Cell; Cicatrix; Facial Dermatoses; Female; Hodgkin Disease; Humans; Keloid; Keratosis; Male; Middle Aged; Nose; Skin Diseases; Skin Neoplasms; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Carcinoma, Basal Cell; Eyelids; Facial Neoplasms; Female; Humans; Lip; Male; Maxillofacial Prosthesis; Nose; Scalp; Skin Neoplasms; Skin Transplantation; Surgery, Plastic

Topics: Adult; Aged; Carcinoma, Basosquamous; Female; Humans; Male; Middle Aged; Nose; Skin Neoplasms

Topics: Animals; Carcinoma, Squamous Cell; Fishes; Male; Nose; Skin Neoplasms

Topics: Breast Diseases; Congenital Abnormalities; Humans; Nevus; Nevus, Pigmented; Nose; Nose Deformities, Acquired; Obesity; Plastics; Prognathism; Skin Neoplasms; Surgery, Plastic

Topics: Adolescent; Adult; Aged; Humans; Middle Aged; Nevus, Pigmented; Nose; Skin Neoplasms

Topics: Carcinoma, Adenoid Cystic; Humans; Neoplastic Syndromes, Hereditary; Nose; Nose Neoplasms; Skin Neoplasms; Surgical Procedures, Operative

Topics: Humans; Nevus; Nevus, Pigmented; Nevus, Sebaceous of Jadassohn; Nose; Nose Neoplasms; Pathology; Sebaceous Glands; Skin Neoplasms; Surgical Procedures, Operative

Topics: Cysts; Fistula; Humans; Nose; Skin Neoplasms

Topics: Breast; Cleft Lip; Humans; Nevus; Nevus, Pigmented; Nose; Nose Neoplasms; Skin Neoplasms; Surgery, Plastic

Topics: Carcinoma, Adenoid Cystic; Humans; Neoplastic Syndromes, Hereditary; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Nasal Cavity; Neoplasms; Nose; Papilloma; Paranasal Sinus Neoplasms; Skin Neoplasms

Nevi are the most common tumors of childhood. Pigmented nevi are classified into blue nevi, intraepidermal nevi, junction nevi, intradermal nevi (or common mole) and combination types. Cutaneous malignant disease in children is rare. Malignant melanoma is rare before puberty. Wholesale removal of benign pigmented nevi in children should be condemned. However, junction nevi located on the palms, soles, genitalia or waistline-that is, in areas subject to frequent trauma-should be excised. Hemangiomas in infants are the most common tumors for which advice is sought. Not all hemangiomas regress spontaneously, and on occasion the persistence or progression of such a lesion may bring about life-long unsightly deformities. Therapy for this type of tumor is simple when given early in life. Hemangiomas involving the ears, nose, lips or eyelids should be treated at once, preferably within a month of the time they appear.

Topics: Administration, Cutaneous; Child; Disease Progression; Eyelids; Foot; Hemangioma; Humans; Infant; Lip; Melanoma; Nevus; Nevus, Blue; Nevus, Epithelioid and Spindle Cell; Nevus, Intradermal; Nevus, Pigmented; Nose; Skin Neoplasms

Topics: Carcinoma, Adenoid Cystic; Humans; Neoplasms; Neoplastic Syndromes, Hereditary; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Ear, External; Humans; Neoplasms; Nose; Nose Neoplasms; Skin Neoplasms

Basal cell carcinomas of the nose probably originate from embryologic cell rests left between cartilages and bones in the fusion and migration of the nasal precursors. Some carcinomas have been found to invade to the mucosal surface between subcutaneous structures or around the alar margins. Recurrences are particularly likely to develop deep extensions due to overlying scar tissue. In many cases, chemosurgical removal has disclosed unsuspected deep and lateral extensions. It is the treatment method of choice for many such lesions.

Topics: Bone and Bones; Carcinoma, Basal Cell; Choice Behavior; Cicatrix; Disclosure; Humans; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Skin Neoplasms; Treatment Outcome

Topics: Cysts; Humans; Lip; Nose; Nose Diseases; Skin Neoplasms

Topics: Carcinoma, Basal Cell; Humans; Neoplasms; Nose; Nose Neoplasms; Orbit; Orbital Neoplasms; Radiotherapy; Skin Neoplasms

Topics: Carcinoma, Adenoid Cystic; Humans; Nasal Cavity; Neoplasms; Neoplastic Syndromes, Hereditary; Nose; Paranasal Sinus Neoplasms; Paranasal Sinuses; Skin Neoplasms

Topics: Carcinoma, Squamous Cell; Humans; Lip; Nose; Skin Neoplasms; Xeroderma Pigmentosum

Topics: Carcinoma, Basal Cell; Humans; Neoplasm Recurrence, Local; Neoplasms; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Cysts; Humans; Nose; Nose Diseases; Skin Neoplasms

Topics: Forehead; Humans; Neoplasms; Nose; Nose Neoplasms; Skin Neoplasms

Topics: Cysts; Humans; Nose; Skin Neoplasms

Topics: Cysts; Nose; Nose Diseases; Skin Neoplasms

Topics: Cysts; Nose; Nose Diseases; Skin Neoplasms

Topics: Condylomata Acuminata; Humans; Neoplasms, Connective Tissue; Nose; Pelvic Neoplasms; Skin Neoplasms; Syphilis; Syphilis, Cutaneous

Topics: Cysts; Humans; Nose; Nose Diseases; Skin Neoplasms