This 68 year-old man was referred by his primary care physician in Camarillo for treatment of a basal cell carcinoma on the alar sill of the left upper lip. The skin cancer had been present for five years before he sought treatment.
The patient required two stages of Mohs micrographic surgery to clear the skin cancer, and the defect after removal of the skin cancer was 2.5 x 1.8 cm. The “stages” in Mohs surgery are the number of times that the surgeon removes a tiny margin of tissue around the obvious skin cancer. The Mohs surgeon starts with a narrower margin than is used with standard excision or frozen section surgery. As a result, by tracing out the roots of the skin cancer stage by stage the cure rate is higher and the surrounding normal healthy tissue is preserved.
An island pedicle advancement flap was designed to reconstruct the alar sill. This repair prevented blunting of this area connecting the upper lip, nose and cheek.
