• Adam J Mamelak, Steven Q Wang, and Leonard H Goldberg.
• DermSurgery Associates, Houston, TX 77030, USA.
• J Drugs Dermatol. 2009 Jan 1; 8 (1): 23-8.

BackgroundSkin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a challenge to repair.ObjectiveTo present the authors' experience of using linear closures (LC) to repair surgical defects on the nose in patients who underwent Mohs micrographic surgery (MMS).MethodsA retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postoperative size of the defect, type of malignancy, location of the defect, and final length of the closure. Short-term and long-term complications were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with nasal defects repaired by LC compared to flaps and grafts was also conducted.ResultsThere were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average postoperative defect size was 1.7 x 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Short-term complications were minimal. Nasal asymmetry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group were rated higher than the flap/graft group for lesions on the nose, although this was not statistically significant.ConclusionsA vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous nasal defects whenever possible.

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