Reconstruction of postexcisional defects for periocular giant carcinoma

Abstract

Introduction. The giant basal cell carcinoma is a rare skin malignity, representing only 1% of the basal cell carcinomas. The giant type is defined as the lesion which exceeds 5 cm in diameter. The disease is reported generally in persons in their seventh decade of life, patients with various other pathologies. The excisions within oncological limit lead to large soft tissue defects which, if localized at the periocular region, become a real challenge for the surgeon that has to choose a surgical technique for the reconstruction. Aim of the study. To show some technical solutions to cover soft tissue defects from the periocular level left after excision for giant carcinomas and their results. Materials and methods. The study includes 9 patients, 8 male and one woman, age between 60 to 85 years, with a history of carcinomatous lesions in evolution from 7 to 12 years. All the lesions have dimensions between 5 and 7.5 cm, located in four cases in the external angle of the right eye,two at the upper eyelid and the external angle of the left eye, and, in one case, in theglabellar region with extension at both eyes. In all of the 8 cases the intervention consisted in complete excision (with oncological limit restriction) and covering with regional flaps (in 3 cases Mustarde flap, in 3 cases association of frontal flaps and in 3 cases genian advancement flap, from witch, one anchored in the zygomatic bone). All the reconstructive surgical interventions were performed in one operatory time, only in two cases it was necessary the reintervention after three months for the sectioning of the conjunctival flap (for the eyeprotection). In all 8 cases the nodular form of the basal cell carcinoma was observed. Results. The immediate postoperative evolution was good, without flap vascularisation problems. Long term evolution was good, with full reintegration of the flaps and a pleasant esthetic result. No recurrences were registered 18 months after the intervention. Conclusions. The giant basal cell carcinoma, a rare form of disease, is most often diagnosed at advanced ages. On the face, excision determines the presence of large soft tissue defect. Sometimes the reconstruction represented a real challenge for the surgeon.