Reconstruction of Lateral Tip and Ala

Abstract

A 44-year-old woman developed melanoma of the left alar groove. This was resected by her referring dermatological surgeon, and the patient was referred for wider surgical margins. She was in excellent health and did not have other cutaneous malignancies. Examination of the nose revealed a 0.8-cm ulcer in the anterior portion of the alar groove where the wound had been left open following her resection. A chest radiograph revealed no evidence of metastases. Pathological examination of the excised specimen showed a melanoma of a Breslow level of 2.13 mm. The recommended treatment was full-thickness resection of the tumor with a 1.5-cm wide soft-tissue margin (Fig. 23.1). The tumor was excised by removing the entire ala, lateral tip, and caudal portion of the sidewall to the level of the base of the pyriform aperture. The lateral crus and upper lateral cartilage were included in the specimen. Resection left a 3.0 × 2.75 cm full-thickness defect of the left nose (Fig. 23.2).