Linear closure for nasal defects after Mohs micrographic surgery

Background: Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a challenge to repair. Objective: To present the authors' experience of using linear closures (LC) to repair surgical defects on the nose in patients who underwent Mohs micrographic surgery (MMS). Methods: A retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postoperative size of the defect, type of malignancy, location of the defect, and final length of the closure. Short-term and long-term complications were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with nasal defects repaired by LC compared to flaps and grafts was also conducted. Results: There were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average postoperative defect size was 1.7 X 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) . Short-term complications were minimal. Nasal asymmetry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group were rated higher than the flap/graft group for lesions on the nose, although this was not statistically significant. Conclusions: A vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous nasal defects whenever possible.