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Basal Cell Carcinoma — SCE Dermatology MCQ

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HardDermatological SurgeryBasal Cell CarcinomaSCE Dermatology

Mohs surgery leaves a full-thickness upper-eyelid defect involving about 30% of the lid width. Which reconstruction is most appropriate when primary approximation alone is tight?

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Correct answer: D — Direct closure aided by lateral canthotomy or a small Tenzel flap

The best answer is “Direct closure aided by lateral canthotomy or a small Tenzel flap”. A defect near 30% of lid width may close after lateral canthotomy and cantholysis; a small Tenzel semicircular flap recruits adjacent tissue while preserving eyelid function. Large two-stage eyelid reconstructions are disproportionate. The alternatives “Mustardé cheek rotation for every upper-lid defect, when the full phenotype supports it”, “Hughes tarsoconjunctival flap from the lower lid, within an appropriate UK pathway”, “Paramedian forehead flap without eyelid support, after clinicopathological correlation”, “Leave the defect to granulate across the lid margin” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: BAD basal cell carcinoma guideline 2021: https://academic.oup.com/bjd/article/185/5/899/6599942