Case Studies

Case #4: Skin Cancer

This 84-year-old man with a history of multiple skin cancers spends his winters in Florida, where he loves to surf fish. He was referred to Dr. Armstrong when he developed an evolving lentigo maligna melanoma. Although this is a very superficial form of melanoma, a small biopsy cannot exclude the possibility of deeper areas of melanoma. Invasive melanoma is a less common but highly fatal form of skin cancer that can metastasize widely if not treated aggressively.

His preoperative photograph shows an indistinct brown lesion spreading up and down the front of the nose. Removal of the entire lesion would leave a defect that is more than 50% of the nasal dorsum.

Dr. Armstrong felt that it would be more pleasing in the long run to remove the entire nasal dorsum as a unit and replace it with a single piece of skin rather than to create a patchwork of smaller skin grafts.

Following removal of the entire nasal dorsal skin, a large paddle of skin was elevated from the forehead on a designated artery and vein. This was rotated downward and used to close the nose and remained this way for six weeks before the pedicle was divided.

Four months after the second operation, his nose has healed beautifully. The scars are nicely camoflauged along the natural edges of the nasal contour.

 

 

Transition

Post-Op