Novel management of scarred recurrent intradermal nevus on the nasal tip through tri-lobe flap and scar resurfacing

Incomplete removal of a nevus can lead to recurrence and scarring, requiring revision for optimal outcomes. A 36-year-old female presented with a recurrent nasal supra-tip intradermal nevus after failed treatments, including shave excision, hyfrecation, erbium, and fractional carbon dioxide (CO2) lasers. She developed a hypopigmented plaque with fibrosis and residual nevus tissue, confirmed by ultrasound and histopathological examination. Excision with a trilobe transposition flap restored nasal contour while minimizing asymmetry. Histopathology confirmed residual intradermal melanocytic nevus (congenital type) with characteristic melanocyte nests in the papillary dermis and melanocytes splayed between collagen bundles in the reticular dermis, along with secondary fibrosis from previous procedures. Clear margins were achieved in one stage. Postoperative scar management with dermabrasion, fractional CO2 laser, and pulsed dye laser improved esthetics. This case underscores the importance of proper nevus removal and the trilobe flap as an effective reconstructive approach for appropriately sized nasal defects, while demonstrating how multimodal treatment can optimize outcomes.