Basal Cell Carcinoma — SCE Dermatology MCQ

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HardDermatological SurgeryBasal Cell CarcinomaSCE Dermatology

A 56-year-old man presents with a non-healing ulcer on his nose following Mohs surgery for BCC 3 weeks ago. The defect is 1.5 cm with exposed nasal cartilage. What is the most appropriate reconstructive option?

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Correct answer: C — Local flap (e.g. bilobed or nasolabial transposition flap)

For nasal defects following Mohs surgery with exposed cartilage, local flaps are generally preferred. The bilobed flap and nasolabial transposition flap are workhorse reconstructive options for nasal defects as they provide tissue of similar colour, texture, and thickness. Full-thickness skin grafts may be used for smaller defects or where cartilage has intact perichondrium. Split-thickness grafts have poor cosmetic outcome on the nose. Exposed cartilage without perichondrium does not support graft take. Secondary intention healing may lead to unfavourable contraction and cosmesis on the nose.

Reference: BAD 2021 BCC Guidelines; Dermatological Surgery Textbook