DS28: Full-thickness defects of the nose following Mohs micrographic surgery

Catherine Quinlan, Marc Lawrence, Dominic Tabor, David Brass and Thomas Oliphant

Royal Victoria Infirmary, Newcastle upon Tyne, UK

Mohs micrographic surgery (MMS) is often used to treat nonmelanoma skin cancers arising on the nose. Larger basal cell carcinomas (BCC) arising on the nasal ala, and those with aggressive histological subtypes are more likely to result in full-thickness nasal defects (Fletcher KC, Shonka DC, Russell MA, Park SS. Defects of the nasal internal lining: etiology and repair. Arch Facial Plast Surg 2005; 7: 189–94). Our aim was to review all nonmelanoma skin cancers treated with MMS at our department that resulted in full-thickness nasal defects, and to review factors that may predispose to this, what repairs were used and patient satisfaction. We searched the Mohs database at our department from April 2020 to January 2022 to identify cases of full-thickness nasal defects, tumour subtype, histological subtype, patient factors and repairs. We then reviewed patient’s postoperative questionnaires to determine satisfaction with their surgery. A total of 1933 Mohs cases were identified: 1597 were BCCs and 276 were squamous cell carcinomas (SCCs). The total number of nasal lesions treated was 504, of which 16 resulted in full-thickness defects. Of these, 11 were BCC and five were SCC. There were four nodular BCCs, three infiltrative, three mixed nodular and infiltrative, and one basosquamous. Of the SCCs, three were moderately differentiated, one well differentiated and one sarcomatoid. The majority of the lesions were located on the nasal ala (n = 11), with the others on the nasal tip (n = 4) and columella (n = 1). Average maximum tumour diameter was 23 mm (range 8–60). Twelve lesions were ill-defined and ulcerated. Fourteen were primary lesions and two had been treated previously. The average number of Mohs stages was two (range 1–6). The average post-Mohs defect size was 33 mm (range 18–65). Twelve patients had their repair performed by dermatology and four by plastic surgery. Of the dermatology repairs, three had paramedian forehead flaps, three had cheek-to-nose interpolation flaps, two had trilobed transposition flaps, two had island pedicle flaps, one had partial closure with a hinge lining flap and one had secondary intention healing. Of the plastics repairs, all four were paramedian forehead flaps. Eleven patients completed 3-month follow-up questionnaires. Most reported not being bothered at all by their scar, with two reporting being a little bothered and one being bothered a lot. Five patients reported numbness and two reported some ongoing discomfort and difficulty breathing through the nose. In our cohort, most full-thickness nasal defects occurred in patients with large, ill-defined, ulcerated tumours on the nasal ala, and in BCCs with aggressive subtypes. Most were repaired by dermatology using interpolated or local flaps, and the majority of patients were satisfied with their outcome.