May 25, 2012
Topics A-Z Cancer APPROPRIATE BASAL CELL CARCINOMA SURGERY FOR TIP OF NOSE
APPROPRIATE BASAL CELL CARCINOMA SURGERY FOR TIP OF NOSE |
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Dear Ask The Doctor: My husband was diagnosed by a dermatologist with Basal Cell Carcinoma on the tip of his nose and was subsequently referred to a plastic surgeon for removal of it. Surgery was performed Nov 2010. His nose is now terribly scarred. WADSC surgery was performed with an excision from nasal tip of approx. 13 by 17mm. Results of the biopsy were that there was no residual evidence of previously diagnosed BCC. Evidently the dermatologist got it all with his initial biopsy. At my suggestion, my husband did ask the surgeon if it was possible the dermatologist got it all and the surgeon seemed put off by the suggestion as though he knew what he was doing. The surgeon then performed a Superiorly Based V-Y Advancement Flap. My question is, was this level of invasive surgery even necessary? Is it customary to do all this with the end result being the dermatologist got it all with his initial biopsy? Also, given the size of the surgeon's excision, would it have been more appropriate for him to perform just a skin graft as opposed to a flap procedure? Of additional consideration: My husband is a smoker and was not told to cease smoking prior to the surgery. Wouldn't this have been prudent preoperative advice? Should they have performed a flap surgery knowing he was an active smoker? Thank you. Dear MD: It is difficult to determine if your husband required the surgical procedure that was performed without the benefit of having examined him. However, surgical excision is the standard therapy for basal cell cancer and offers a very high cure rate. A flap, such as the one performed, is also the standard of care after excision of this type of cancer. Skin grafts do not heal well in areas where cartilage is exposed and therefore are not routinely performed. While smokng cessation prior to surgery would have been good. It is not a requirement to perform this type of surgery. Chronic smoking would increase the likelihood of developing complications related to anesthesia. It would have no direct effect on the flap or how it heals. |
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| Last Updated ( Friday, 05 August 2011 ) |
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