Black Tumor

SavageGlow · #1 ● 08-01-2024, 07:44 PM

A black tumor was present in the apex of the nose over the bilateral alae and diagnosed as malignant melanoma on dermoscopy (Fig. 2). In the first surgery, the tumor was resected with a 1-cm margin on the perichondrium, and artificial dermis was applied to the skin defect.

The pedicle (about 1 cm or narrower ) was prepared on the supra-trochlear artery and vein, and the incision was extended toward the cranial side corresponding to the distance to the defect and then toward the lateral side matching to the defect morphology so as to prepare a paramedian forehead flap with a design consistent with the esthetic unit contain-ing the defect.

Incision and dissection was performed on both sides of the flap to the depth of the periosteum in par-allel to the long axis of the flap, and a flap containing the frontalis muscle and superficial layer of the temporal fascia was prepared. No skin incision was made at the central or the peripheral side of the flap.

The flap was dissected on the periosteum as a bipedicle flap, and surgery was completed by suturing (Fig. 1).

The second surgery was performed after confirming the results of histopathological examination, but basically, it is better to perform the surgery within 10–14 days when the effect of the delay becomes marked.

Granulation of the artificial dermis in the skin defect was removed, the paramedian forehead flap was elevated to match with the esthetic subunit, and the defect was covered.

Thinning of the region around the flap was performed at the same time. For the flap donor region to which plication is not applicable, skin grafting was performed.