Oncological treatment and upper lip reconstruction in basal cell carcinoma: case report and review of reconstructive options

Authors

  • Carla M. Cruz Rocha Department of General Surgery, Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
  • Jose D. Tellez Gonzalez Department of General Surgery, Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
  • Danna Gonzalez Delgado Department of General Surgery, Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
  • Liliana A. Cuevas Mejia Department of General Surgery, Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
  • Besser I. Irias Vasquez Department of General Surgery, Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
  • Daniela I. Sanchez Lozano Department of General Surgery, Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
  • Carlos A. Bautista Lopez University Center for Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico
  • Maria del C. Torres Gonzalez University Center for Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20263000

Keywords:

Basal cell carcinoma, Mohs surgery, Upper lip, Local flaps, Facial reconstruction

Abstract

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and frequently affects sun-exposed facial regions. Lesions of the upper lip are considered high risk due to their tendency for local invasion, recurrence, and involvement of critical functional and aesthetic subunits. Optimal management requires complete oncologic excision followed by anatomically precise reconstruction.  We report the case of a 66-year-old woman with a recurrent nodular BCC of the upper lip after prior incomplete excision. Margin-controlled surgical resection was performed with intraoperative frozen-section analysis. Persistent deep margin involvement required extension of the excision to include the upper lip, anterior nasal vestibule floor, and premaxillary periosteum, resulting in a defect involving approximately 40% of the upper lip. Immediate reconstruction was carried out using a layered anatomical approach, including separate repair of the mucosa and orbicularis oris muscle, bilateral perialar advancement flaps, and an additional local cutaneous flap to reconstruct the central tubercle. This case highlights the importance of achieving complete tumor clearance in recurrent BCC, particularly in high-risk anatomical regions such as the upper lip. Reconstructive planning must balance oncologic safety with restoration of oral competence, symmetry, and aesthetic subunits. Local advancement flaps, especially perialar techniques, represent reliable options for moderate defects (30–50%), providing good functional and cosmetic outcomes when combined with meticulous layered repair. The presence of recurrence and periosteal involvement underscores the need for multidisciplinary evaluation, including consideration of adjuvant therapies. Recurrent upper-lip BCC requires an integrated approach combining aggressive oncologic resection with tailored reconstruction. Layered repair and local advancement flaps allow effective restoration of both function and aesthetics in moderate-sized defects, supporting their role as first-line reconstructive options in appropriately selected cases.

 

References

Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med. 2005;353:2262–9.

Wong CS, Strange RC, Lear JT. Basal cell carcinoma. BMJ. 2003;327:794–8.

Marzuka AG, Book SE. Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Yale J Biol Med. 2015;88(2):167-79.

Crowson AN. Basal cell carcinoma: biology, morphology and clinical implications. Mod Pathol 2006;19 Suppl 2:S127–47.

Scrivener Y, Grosshans E, Cribier B. Variations of basal cell carcinoma according to site and histological subtype. Br J Dermatol. 2002;147(1):41-7.

Sexton M, Jones DB, Maloney ME. Histologic pattern analysis of basal cell carcinoma. J Am Acad Dermatol. 1990;23(6 Pt 1):1118-26.

Betti R, Menni S, Bombonato C, Crosti C. Histologic variants of basal cell carcinoma. J Am Acad Dermatol. 1997;37(3 Pt 1):430-7.

Rowe DE, Carroll RJ, Day CL. Long-term recurrence rates in basal cell carcinoma. J Dermatol Surg Oncol. 1989;15(3):315-328.

Chren MM, Torres JS, Stuart SE, Bertenthal D, Labrador RJ, Boscardin WJ. Recurrence after treatment of nonmelanoma skin cancer: a prospective cohort study. Arch Dermatol. 2011;147(5):540-6.

Lee EH, Shin JH, Roh MR. Recurrence of basal cell carcinoma: influence and prevention. Dermatol Surg. 2017;43(4):484-91.

Schmults CD, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, et al. Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023;21(11):1181-203.

Smeets NW, Kuijpers DI, Nelemans P, Ostertag JU, Verhaegh ME, Krekels GA, et al. Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature. Br J Dermatol. 2004;151(1):141-7.

Mosterd K, Krekels GA, Nieman FH, Ostertag JU, Essers BA, Dirksen CD, et al. Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up. Lancet Oncol. 2008;9(12):1149-56.

Mosterd K, Krekels GA, Nieman FH, Ostertag JU, Essers BA, Dirksen CD, et al. Five-year results of a randomized controlled trial comparing surgical excision and Mohs micrographic surgery for facial basal cell carcinoma. J Invest Dermatol. 2010;130(5):1358-64.

Thomson J, Hogan S, Leonardi-Bee J, Williams HC, Bath-Hextall FJ. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev. 2020;11(11):CD003412.

Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, et al. Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines. Eur J Cancer. 2019;118:10-34.

Work Group, Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Moyer J, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540-59.

McCarn KE, Park SS. Lip reconstruction. Facial Plast Surg Clin North Am. 2005;13(2):301-14.

Thornton JF, Griffin JR, Constantine FC. Nasal reconstruction: an overview and nuances. Semin Plast Surg. 2008;22(4):257-68.

Avci O, Kocaoglu M. Practical approach to upper lip reconstruction. Ann Plast Surg. 2021;86(6):713-9.

Liapakis IE, Karypidis D, Pappas A, Boboridis KG, Christensen L, Karandreas N, et al. Advancement flaps in upper lip reconstruction. J Oral Maxillofac Surg. 2020;78(6):985.e1-985.e7.

Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg. 1985;76(2):239-47.

Few JW, Sykes JM. Functional and aesthetic outcomes in lip reconstruction. Clin Plast Surg. 2005;32(3):431-45.

Baker SR. Local flaps in facial reconstruction. 3rd ed. Philadelphia, PA: Elsevier; 2014.

Zoumalan RA, Hazani R, Levine JL. Principles of facial reconstruction. New York, NY: Springer; 2012.

Weedon D. Skin pathology. 4th ed. London, UK: Elsevier; 2016.

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Published

2026-08-26

How to Cite

Rocha, C. M. C., Gonzalez, J. D. T., Delgado, D. G., Mejia, L. A. C., Vasquez, B. I. I., Lozano, D. I. S., Lopez, C. A. B., & Gonzalez, M. del C. T. (2026). Oncological treatment and upper lip reconstruction in basal cell carcinoma: case report and review of reconstructive options . International Surgery Journal, 13(9), 1714–1719. https://doi.org/10.18203/2349-2902.isj20263000

Issue

Vol. 13 No. 9 (2026): September 2026

Section

Case Reports
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