title: Defects of the nasal internal lining: etiology and repair.
abstract: OBJECTIVE
  To analyze risk factors leading to full-thickness (FT) defects, to review methods of repair, and to present guidelines for management of aggressive basal cell carcinomas (BCCs) of the nose.
  
  
  METHODS
  Retrospective medical chart review of patients who underwent nasal reconstruction by the Department of Otolaryngology-Head and Neck Surgery between 1996 and 2003.
  
  
  RESULTS
  Two hundred ten patients underwent nasal reconstruction; 183 had complete medical records and were included in this study. There were 53 patients with FT nasal defects, 38 (71.7%) of which were due to BCC. Among all patients presenting with an aggressive histologic subtype of BCC, 30.1% (22/73) developed FT defects. In contrast, 14.5% (16/100) with a nonaggressive subtype had FT involvement (P < .05).
  
  
  CONCLUSIONS
  Internal lining defects are more likely to occur from aggressive histologic subtypes of BCC (infiltrative, morpheaform, and micronodular) than nonaggressive subtypes (P < .05). For BCCs 1 to 2 cm2 located on the nasal ala, histologic subtype is a significant risk factor for resulting in a FT defect, which should influence the method of excision (direct vs Mohs micrographic surgery) and the anticipated reconstruction. Large lesions (> 2 cm2) involving the ala have a high rate of internal lining involvement independent of pathologic subtype.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, University of Virginia Medical Center, Charlottesville, VA 22908, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Fletcher
authors.forename: David C
authors.initials: DC
authors.lastname: Shonka
authors.forename: Mark A
authors.initials: MA
authors.lastname: Russell
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Park
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000503:physiopathology / Q000601:surgery; D009297:Nasal Mucosa / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology