Simplifying nasal reconstruction after Mohs surgery: an algorithm based on review of over 400 cases

The literature is lacking on reconstruction techniques for post-Mohs nasal defects with particular emphasis on the unique properties of underlying skin. We aimed to develop an algorithm to simplify the approach to post-Mohs reconstruction of the nose based on defect size, location and cutaneous features of the surrounding skin. A retrospective review of 404 patients who underwent post-Mohs nasal reconstruction by a single Mohs surgeon between 2018 and 2024 was conducted. Defects were divided into small, medium and large sizes. Locations were categorized into three zones based on cutaneous characteristics. The frequency of reconstructive techniques based on defect size and location was analysed. Trends towards specific repairs based on the cutaneous location and size of Mohs defects were used to develop an algorithm for reconstructive decision making. This algorithm was based on zones defined by cutaneous characteristics. It may serve as an initial guide for surgeons planning reconstruction of nasal defects.