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Chirurgia 2007 October;20(5):273-6


language: English

Aggressive basalioma cell carcinoma of the nose. Surgical management in a patient with multiple neoplastic relapses

Chiummariello S. 1, Monarca C. 2, Rizzo M. I. 2, Pacitti F. 2, Noviello A. 1, Alfano C. 1

1 Department of Plastic and Reconstructive Surgery University of Perugia, Perugia, Italy 2 Department of Dermatology and Plastic Reconstructive Surgery La Sapienza University, Rome, Italy


Basal cell carcinoma (BCC) is one of the most common skin malignancy with a prevalence for Cuacasian individuals. BCC grow by direct extension creating anatomical changes by local tissue destruction; they infrequently metastasize and are an uncommon cause of death. However, BCC may cause severe local tissue damage, which often expands to contiguous cartilage, muscle, and bone with a biological destructive behaviour; so it is then termed “aggressive BCC”. BCC of the nose are frequently highly aggressive tumours with wide cutaneous-subcutaneous growth and/or infiltrative growth pattern, especially when located at the columellar base, at the alar nose, and toward the inner chantal region. Rapid extension of cancer to the adjacent bony and cartilaginous facial structures requires extensive oncological resections for control. We presented a 69-year-old white male. He was originally diagnosed with BCC of nose back in 2001 by an excisional biopsy and histological examination. In April 2001, the patient developed a local (nose back) recurrence of BCC. Histological evaluation demonstrated a metatypical and infiltrative BCC pattern with margins disease free. In May 2003, the patient developed another local recurrence of BCC involving the left alar nose and the omolateral cheek. Histological evaluation demonstrated a metatypical and infiltrative BCC pattern, with margins disease free of the left nasal wing but nasal vestibule cancer implication. In September 2003, he underwent another local wide resection of left nasal wing since to the maxillary bone (excluded) without “deficit” area reconstruction. Patient underwent another surgical procedure in June 2004, consisted on wide resection of the neoplasm recurrence extending to left nasogenal area, nasal pyramids, and maxillary sinus in its anterior wall. Selective left laterocervical node dissection was performed. Histological evaluation demonstrated a metatypical solid infiltrative BCC pattern with all margins and lymph nodes disease free. November 2005 a pre-expanded forehead flap was made to reconstruct the residual nose and left cheek deficit. Actually, patient at 3 months follow- up remain disease free.

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