Reconstructive Challenges in Recurrent Nasal Basal Cell Carcinoma: Multidisciplinary Management and Paramedian Forehead Flap Reconstruction in an Elderly Patient

Basal cell carcinoma involving the nose may require extensive surgical excision, resulting in complex defects that present both functional and aesthetic reconstructive challenges, particularly in patients with recurrent disease or previous radiotherapy. We report the case of a 73-year-old woman with a history of recurrent basal cell carcinoma, including prior facial radiotherapy, who presented with a biopsy-proven lesion on the nasal dorsum. Following multidisciplinary evaluation, she underwent wide local excision with histopathological assessment, resulting in a 2 × 2 cm nasal dorsum defect with exposed periosteum and perichondrium. Immediate reconstruction was performed using a paramedian forehead flap to provide adequate soft-tissue coverage. The postoperative course was uneventful, with preserved flap viability and no evidence of ischemia, necrosis, or wound complications. Postoperative wound care included the application of alginate and silicone foam dressings to manage serosanguinous drainage and protect the reconstructed site. Histopathological examination confirmed complete tumor excision with clear margins. At follow-up, the patient demonstrated satisfactory wound healing with favorable functional and aesthetic outcomes and no evidence of early local recurrence. This case highlights the role of multidisciplinary management and paramedian forehead flap reconstruction in achieving successful oncologic and reconstructive outcomes for complex nasal defects following excision of recurrent basal cell carcinoma.