Simultaneous Surgery for Multiple Facial Basal Cell Carcinoma Excision: Modified Hughes Procedure and Rieger Nasal Flap

An 84-year-old female patient initially presented to the general ophthalmology outpatient clinic with a complaint of a mass on the left lower eyelid. At that time, only the eyelid lesion was noted. Upon referral to the oculoplastic unit, an expert oculoplastic surgeon identified, in addition, multiple lesions on the left nasal alar rim. The patient was subsequently referred to the Department of Otorhinolaryngology. Incisional biopsies confirmed basal cell carcinoma in both sites. Under general anesthesia, the ophthalmology and otorhinolaryngology teams performed simultaneous resections and reconstructions in a single operative session. The lower eyelid tumor was excised with tumor-free margins confirmed by frozen section and reconstructed with a Hughes flap. The nasal alar rim lesion was excised with safe margins and repaired with a Rieger flap. Histopathology confirmed nodular and adenoid BCC in both specimens, with all margins clear. The postoperative course was uneventful, and no recurrence was observed during the follow-up. This case highlights 3 key points: ophthalmologists should extend their examination beyond the periocular region to include the entire face; simultaneous multidisciplinary surgery can eliminate the need for additional anesthesia, procedures, and costs; and, to our knowledge, this is the first reported case of synchronous lower eyelid and nasal alar BCCs managed with concurrent Hughes and Rieger flap reconstructions.