This patient was referred to Dr. Morganroth by a dermatologist to treat a morpheaform basal cell carcinoma on the left forehead. Morpheaform basal cell carcinomas are one of the most aggressive histologic subtypes where clinical spread is difficult to ascertain by visual inspection. Defects can be many times larger than expected and can be highly destruction in the central face. This defect is irregular, especially towards the defect nearest the hairline representing the multiple Mohs layers that were required to remove the tumor completely. This defect is not large, but it is large enough that a linear closure would be under high tension with increased risk of poor healing. The other consideration is that a linear closure parallel to the eyebrow will elevate the eyebrow and create a facial asymmetry. Closure in a linear fashion vertically might result in the repair scar impacting the eyebrow and creating an eyebrow defect easily visible by loss of eyebrow hair. In this case, Dr. Morganroth utilized an adjacent transfer of flap to direct tension in the horizontal plane to prevent elevation of the brow and create a geometrical scar that is harder to see (vs. a long linear scar). Dr. Morganroth’s goal is to provide the best possible cosmetic, reconstructive and functional outcome for every patient with nose, eyelid, ear, scalp, face, neck, hand and other skin defects.
