Lateral Forehead Flap in Neglected Giant Basal Cell Carcinoma of the Nose: A Case Report
DOI : 10.33371/ijoc.v13i4.664
Introduction: Neglected basal cell carcinoma (BCC) of the nose can grow into giant BCCs, rare cases with extensive nasal defects. Such large defects would require complex reconstruction such as free flaps or multiple local flaps. Lateral forehead flap may provide a simpler alternative with good functional and cosmetic results.
Case Presentation: We present a case of a 76-year-old man with neglected giant BCC of nose extending to right lower eyelid and upper lip. Wide excision of the tumor leaves a 12cm x 10cm defect. Reconstruction was performed using lateral forehead flap and donor site was covered with split-thickness skin graft from thigh. The second surgery was done after four months to create nostrils and wider eye-opening. Six months later, flap was viable and there was no sign of recurrence. Nasal reconstruction is planned to further improve cosmetics. In this case, neglect is due to low social-economic status and adaptation to painless tumors. The use of lateral forehead flap allows for simpler and faster surgery suitable for elderly. Delayed reconstruction was needed to ensure optimal tissue healing.
Conclusions: Neglected BCC causes disfigurement with remarkable morbidity, requiring complex reconstruction. The lateral forehead flap is a simple and reliable reconstruction method for extensive nasal defects with good functional and cosmetic outcomes.
- Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept. 2017;7(2):1.
- American Cancer Society (2018) Facts & Figures 2018. American Cancer Society, Atlanta. https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/key-statistics.html#references. Accessed 21 November 2018.
- Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatology. 2015;151(9):976. https://doi.org/10.1001/jamadermatol.2015.1188.
- Malec K, Brzewski P, Cenda P, Kuchta K. Gasinski M, Wojas-Pelc A, et al. Extensive, neglected basal cell carcinoma of the half of the face-surgical treatment and reconstruction with an anterolateral microvascular thigh ﬂap. Adv Dermatol Allergol. 2016;33(3):235-8.
- Larsen AK, Ghulam W, El-Charnoubi. Gehl J, Krag C. Neglected giant scalp basal cell carcinoma. Plast Reconstr Surg Glob Open. 2014;2:e120.
- Varga E, Korom I, Rasko Z, Kis E, Varga J, Olah J, et al. Neglected basal cell carcinoma in the 21st century. J Skin Cancer. 2011;2011:392151.
- McGregor IA. The temporal flap in intra-oral cancer: its use in repairing the post-excisional defect. Br J Plast Surg. 1963;16:318-35.
- Millard DR, Jr. Forehead flap in immediate repair of head, face and jaw. Am J Surg. 1964;108:508-13.
- Bisgaard E, Tarakji M, Lau F, Riker A. Neglected skin cancer in the elderly: a case of basosquamous cell carcinoma of the right shoulder. J Surg Case Rep. 2016;2016(8):rjw134.
- Wandrey N, Chen T, Eng T. Dramatic resolution of an unresectable giant basal cell carcinoma treated with intensity-modulated radiation therapy (IMRT) - a case report. Cureus. 2015;7(12):e416.
- Lackey PL, Sargent LA, Wong L, Brzezienski M, Kennedy JW. Giant basal cell carcinoma surgical management and reconstructive challenges. Ann Plast Surg. 2007;58(3):250-4.
- Archontaki M, Stavrianos SD, Korkolis DP, Arnogiannaki N, Vassiliadis V, Liapakis IE, et al. Giant basal cell carcinoma: clinicopathological analysis of 51 cases and review of the literature. Anticancer Res. 2009;29(7):2655-63.
- Arslan H, Güzel MZ, Cnar C. Treatment of giant basal cell carcinomas of the head and neck with aggressive resection and complex reconstruction. J Craniofac Surg. 2012;23(6):1634-7.
- Chim H, Salgado CJ, Seselgyte R, Wei FC, Mardini S. Principles of head and neck reconstruction: an algorithm to guide flap selection. Semin Plast Surg. 2010;24(2):148-54.
- Supit L, Sudjatmiko G. The extended lateral forehead flap: today as was 50-years ago. Jurnal Plastik Rekonstruksi. 2012;1(4):374-80.
- Boyd CM, Baker SR, Fader DJ, Wang TS, Johnson TM. The forehead flap for nasal reconstruction. Arch Dermatol. 2000;136:1365-70.
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