This 18 year-old man was referred by his physician in Santa Ynez for treatment of a basal cell carcinoma on the left nasal sidewall. The patient first noticed the lesion 5 months earlier.
The skin cancer was removed by Mohs micrographic surgery, leaving a 1.2 x 1.2 cm surgical defect. To reconstruct this defect in a young patient with minimal adjacent loose skin, a bilobed transposition flap was performed. This flap is frequently used for reconstruction of the nose because it allows movement of tissue on the nose from where it is most abundant (the proximal two-thirds) to where it is deficient (the distal one-third of the nose). Effectively, the needed skin and soft tissue is “walked down” the nose to the surgical defect. The wound healed well. Dermabrasion was offered to the patient to soften the scar, but he was very satisfied with the appearance and returned to his doctor for continued care.