Reconstruction of Large Nasal Alar Squamous Cell Carcinoma Defect Using a Superiorly - Based Nasolabial Flap

Abstract

 The nasal skin is the most common site of malignancy in the face accounting for as much as 25.5 percent by virtue of its location and propensity for direct exposure to ultraviolet radiation from the sun.^1-3 Among the various cutaneous malignancies, basal cell carcinoma is the most ommon, but other types of cancer such as squamous cell carcinoma, cutaneous malignant melanoma, and basosquamous carcinoma are also common.⁴ Following surgical resection of a malignant lesion, the defect calls for a reconstructive option that will restore aesthetics and function. We present a squamous cell carcinoma of the nasal alar skin which underwent excision and reconstruction of the defect using a superiorly - based nasolabial flap.

CASE REPORT

A 66-year-old man consulted at the outpatient clinic due to a nasal alar mass on the right. The mass started one year prior to consult as a pimple-like lesion on the right nasal ala. There was no history of manipulation or trauma to the aforementioned area. He consulted at a local hospital where he was given unrecalled antibiotics that did not cure the lesion. Instead, he noticed that it gradually enlarged, and a deep ulceration developed within the mass. This prompted consult at our outpatient clinic where a 3 x 2 cm ulcerating mass with crusting and necrotic areas was noted on his right nasal ala. ^{(Figure 1)} Anterior rhinoscopy showed an intact mucosa in the right nostril with no gross evidence of tumor involvement. There were no enlarged cervical lymph nodes palpated in the neck. A wedge biopsy revealed a well-differentiated squamous cell carcinoma. He claimed that he had no family history of cutaneous malignancy. However, he had a 20 pack-year history of smoking and was a heavy alcoholic beverage drinker. He previously worked as an electrician and denied chronic exposure to sunlight.

He consequently underwent excision of the right nasal alar mass with 5-mm margin. (Figure 2A, B) A histologic evaluation of the margins revealed that the borders and tumor base were negative for malignancy. The alar cartilage was not involved by tumor. Reconstruction of the defect was done using a superiorly - based nasolabial flap on the right. (Figure 3A, B, C) Two weeks postoperatively, the patient came in for follow-up with a healed, aesthetically - pleasing, and well-coaptated wound. (Figure 4) He remains free of any evidence of recurrence after 1 year.