This patient sought the highest cure rate for a basal cell carcinoma on the nasal tip and selected Dr. Morganroth, a double board-certified Mohs surgeon to perform the Mohs and reconstruction. Following clearance of the nasal tip basal cell carcinoma by Mohs surgery, the skin defect was the smallest possible size and the cure rate was 99%. The nasal tip location, especially on the nose of a young patient, presents one of the most difficult challenges for a reconstructive surgeon. The nasal skin reflects overhead light and scars are very difficult to hide.
The options for this defect include: allowing the defect to heal on its own; adjacent tissue transfer or flap; full thickness skin graft; and a forehead flap (a complicated flap that only a handful of Mohs surgeons perform and is illustrated in Case 11 and 12).
This patient sought the best possible reconstruction and selected Dr. Morganroth for his innovative techniques and ability to repair the defect on the same day as Mohs surgery under local anesthesia. The most common flap that Dr. Morganroth and others perform for a defect of this size and location is the bilobed transposition flap which mobilizes skin from the loose skin on the nasal bridge and moves it to the nasal tip (where there is no loose skin). The downside of the flap is trapdooring or thickening of the nasal skin that is moved into the nose defect. Dr. Morganroth modified the standard bilobed transposition flap to greatly reduce the chance of trapdooring. Cases 4, 5, 6, 7, 8 and 9 are examples of this technique. Case 6 is an interesting bilobed transposition flap example where Dr. Morganroth did not use his modification of the flap to encourage trapdooring of the flap to restore the round shape to the side of the nasal tip.
