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Nasal Reconstruction — SCE Dermatology MCQ

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HardDermatological SurgeryNasal ReconstructionSCE Dermatology

Mohs surgery leaves a 1.5 cm full-thickness defect centred on the nasal ala. Which regional reconstructive option best restores alar contour while limiting retraction?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — A staged nasolabial interpolation flap with structural support as needed

The best answer is “A staged nasolabial interpolation flap with structural support as needed”. A 1.5 cm alar defect needs replacement tissue with reliable vascularity and preservation of the free margin. A nasolabial interpolation flap is a regional workhorse; cartilage support may be added to resist notching or collapse. The alternatives “Paramedian forehead flap for this isolated small alar defect”, “Primary closure across the alar rim under tension”, “Full-thickness skin graft without structural assessment, after clinicopathological correlation”, “Secondary intention across the entire free margin, after specialist assessment” 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