The skin cancer growing on Carolyn Bohlmann’s nose was not a very aggressive variety. But it was deep and located right on her nostril. The tricky part was not so much removing it – MOHS surgery, the procedure Bohlmann had, is a fairly common outpatient procedure.
The tricky part would be reconstructing her nostril so that it didn’t lift up or droop down. It’s an important cosmetic issue, but it’s also critical for breathing.
Bohlmann opted for a new reconstruction technique her surgeon, Jeffrey Moyer, M.D., was offering at the University of Michigan Comprehensive Cancer Center. Moyer removed some cartilage from behind Bohlmann’s ear and skin from her shoulder and shaped it to create a new nostril in the place where the tumor had been growing.
Dr. Moyer, an associate professor of otolaryngology, and his colleagues recently reported on the first 20 patients to undergo this new procedure. Here, he explains what they learned and how it gives people with skin cancer on the nose another option.
Dr. Moyer: The nose is a fairly complicated area to reconstruct. To maintain both the aesthetic and the functional aspects, you have to maintain a three-dimensional structure. This means you can’t just use skin – you need something with structure to prevent the nostril from collapsing or pulling up.
mCancer Partner: So what traditionally have you done to reconstruct the nostril?
Dr. Moyer: Ear cartilage works well, but you also need a blood supply, which we get from skin on the forehead or cheek. That creates a skin flap that stays on for about three weeks, allowing the blood vessels to grow. Then we go back in to separate out the skin flap. That means the patient needs to come back for a second procedure.
mCancer Partner: How does your new technique differ?
Dr. Moyer: We demonstrated that we can put the cartilage in without the blood supply, which saves patients from that second procedure – but still maintains the ability to breathe and a good cosmetic result. We do these cheek flaps just because we need the blood supply, but we don’t need the tissue. It turns out you don’t need the blood supply either.
mCancer Partner: Why is this important for patients?
Dr. Moyer: This technique is a single procedure, so it could save people a lot of effort and time. The last thing people want to do is return to the OR. It allows us to spare people multiple surgeries or a scar that dominates the cheek. The cheek flap is still a slightly better cosmetic result, but the incremental benefit may not be worth it for some patients. The ability to do something less but still get the same quality of results is important.
Specialists at the U-M Comprehensive Cancer Center continue to offer this reconstruction technique. For information, call the Cancer AnswerLine at 800-865-1125.
Learn more about repairing the nose after skin cancer:
U-M Comprehensive Cancer Center Press Release: Repairing the nose after skin cancer in just one step
U-M Department of Dermatology: Surgical Dermatology: FAQ
The U-M Dermatology Cutaneous Surgery & Oncology Program is a leader in Mohs surgery, which has been available at U-M since 1955. U-M’s fellowship-trained Mohs surgeons receive extensive post-graduate training in both Mohs surgery and complex reconstruction. They perform approximately 3,500 of these surgeries per year and are experts in their field.
The University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan for cancer patient care. Seventeen multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.