Recurrent basal cell carcinoma of the nasal tip: from dermatological assessment to resection and reconstruction with a local flap

Abstract

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, and the nasal tip is among the highest-risk sites for recurrence because of its complex three-dimensional anatomy and limited local tissue laxity. Tumor persistence after resection with positive margins mandates oncologic re-excision and individualized reconstructive planning. A 62-year-old woman with Fitzpatrick skin type II and a history of nasal-tip BCC excision with positive surgical margins presented with a 2.5 cm pearly, slow-growing neoformation arising over the previous scar, with a dermoscopic pattern consistent with recurrence. She was referred to plastic and reconstructive surgery, where a paramedian forehead flap was initially planned. Intraoperatively, after resection of a 2.8 × 2.2 cm defect, the surgical team opted instead for a local Rieger-type (rotation-advancement) flap with extension, achieving a tension-free, single-stage closure without the need for a regional flap. Definitive histopathology reported an infiltrative BCC with tumor-free margins. This case highlights the importance of coordinated care between dermatology and plastic surgery in managing recurrent nasal-tip BCC, and the value of intraoperative reassessment of the reconstructive plan according to the reconstructive-ladder principle, favoring the least complex technique capable of achieving a functional and aesthetically satisfactory result.