Defects of the nasal internal lining: Etiology and repair

Objectives: To analyze risk factors leading to full-thickness (FT) defects, to review methods of repair, and to present guidelines for management of aggressive basal cell carcinomas (BCCs) of the nose. Design: Retrospective medical chart review of patients who underwent nasal reconstruction by the Department of Otolaryngology-Head and Neck Surgery between 1996 and 2003. Results: Two hundred ten patients underwent nasal reconstruction; 183 had complete medical records and were included in this study. There were 53 patients with FT nasal defects, 38 (71.7%) of which were due to BCC. Among all patients presenting with an aggressive histologic subtype of BCC, 30.1% (22/73) developed FT defects. In contrast, 14.5% (16/100) with a nonaggressive subtype had FT involvement (P<.05). Conclusions: Internal lining defects are more likely to occur from aggressive histologic subtypes of BCC (infiltrative, morpheaform, and micronodular) than nonaggressive subtypes (P<.05). For BCCs 1 to 2 cm ² located on the nasal ala, histologic subtype is a significant risk factor for resulting in a FT defect, which should influence the method of excision (direct vs Mohs micrographic surgery) and the anticipated reconstruction. Large lesions (>2 cm²) involving the ala have a high rate of internal lining involvement independent of pathologic subtype.