Basal cell carcinoma (BCC) is the most common skin cancer with more than 80% occurring on the face occurring mainly due to exposure to ultraviolet rays in the elderly due to cumulative exposure of the UV rays during their lifetime. Though various treatment modalities are available for the treatment of basal cell carcinomas, wide local excision is the standard line of management. However, reconstruction of facial BCC poses a challenge to the reconstructive surgeon. Over a 4-year-old period from 2017 to 2021, a total of 30 patients of head and neck basal cell carcinoma were surgically excised in our institution. We have explored all modes of reconstruction from small to large BCC defects in terms of cosmesis, form and function. Four patients underwent primary closure, 8 patients underwent skin grafting, 13 patients underwent closure by local and advancement flaps and 5 patients with large defects underwent free flap reconstruction. No flap loss was reported. None reported any functional deficit. To achieve adequate aesthetic surgical outcomes after reconstruction, knowledge of facial aesthetic regions is of utmost importance. The size and location of the defect and the presence of vital structures adjacent to the defect should be assessed to determine the kind of reconstruction that should be carried out without adversely affecting adjacent structures. For greater patient satisfaction, the method of reconstruction should be tailor made, where donor tissue resembles native tissue with good contour and texture match, suture line scars are camouflaged, and complications are nil.
Keywords: ALT; Basal cell carcinoma; FRAFF; Forehead flap; Free flaps; Giant BCC; Local flaps; Nasolabial flap; Reconstruction; Scalp flap.
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