Nose (Cancer and Reconstruction)



10.1055/b-0034-97697

Nose (Cancer and Reconstruction)

Alison K. Snyder-Warwick & Marissa Tenenbaum
A 59-year-old woman presents to the clinic with a lesion on her nasal tip that she noticed 3 months ago.


Description




  • Full-thickness defect of the sebaceous skin covering the nasal tip.



  • The structural framework and nasal lining are not violated.



  • The defect measures < 1.5 cm in size, which is appropriate for local tissue transposition.



  • Involves one nasal subunit, the tip, but does not violate the remaining aesthetic subunits.



Work-up



History




  • History of sun exposure.



  • Personal or family history of skin cancer.



  • Inherited predisposing conditions




    • Xeroderma pigmentosum, Muir-Torre syndrome, Gorlin syndrome, albinism, basal cell nevus syndrome, others.



Diagnostic studies




  • Full-body integument examination.



  • If patient presents initially without previous treatment, a biopsy should be performed at the time of evaluation to establish a diagnosis.




    • Full-thickness incisional versus excisional biopsies may be performed. Avoid shave biopsies.



Treatment




  • Consider Mohs surgery consultation, if available.




    • Allows examination of ~ 100% of surgical margins; highest cure rates.



    • Board examiner may require that you excise this yourself.



Excision (see Table 6.1)




  • Basal cell carcinoma: 2- to 5-mm margin. Larger margin for aggressive subtypes.



  • Squamous cell carcinoma




    • 4 mm if lesion < 2 cm, well-differentiated, not invasive.



    • 6 mm if lesion > 2 cm, poorly differentiated, invasive into fat, or in high-risk location (central face, ears, scalp, hands, feet, genitalia).



  • Melanoma: Excision margins determined by Breslow thickness.




    • In situ: 5-mm margin.



    • < 1 mm: 1-cm margin.



    • 1 to 2 mm: 1- to 2-cm margin.



    • > 2 mm: 2 cm margin.



    • Stage II melanoma (depth > 2 mm or > 1 mm with ulceration) may require sentinel lymph node biopsy (surgical oncology consultation).



    • Stage III melanoma (positive lymph nodes) may require interferon (medical oncology consultation).

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Nose (Cancer and Reconstruction)

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