Is Moh's Surgery Appropriate Following Plastic Surgery Doing an Excision of a Keratoacanthoma with Skin Grafts and Cartilage Removal of the lower right side of nose; now with path. report showing 'squamous cell ca' at the deeper and most lateral margins. The surgeon had me see a ENT plastic surgeon and they both want to do a 'crane procedure' involving excising tissue from the area until all margins are clear and taking a 'flap' from the forehead and attaching to end of . They told me Moh's in not a good choice for this spot. But told me I'm facing 3-4 surgeries and reconstruction and may lose my nose and possibly AN EYE! I asked the ENT plastic surgeon if the squamous cell ca had invaded an eye(like he said it MAY); would radiation or chemo or some other non-removal of eye work. He said skin ca (squamous cell) doesn't respond well to radiation or chemo; but rather surgical removal. They want to do the 'crane procedure' excising all ca margins until clear and then bringing a 'flap' down from my forehead to attach to end of excised area on nose for blood supply. Is is too late for Moh's if the ca has already
Is This the Right Path I Should Take For Excision of Keratocanthoma?
Doctor Answers (3)
Keratoacanthoma of nose
Sounds like you have an extensive squamous cell cancer of the nose. The tumor needs to be excised by whatever method you are comfortable with. The crane is one way to reconstruct large defects of the nose.
A keratoacanthoma is not a SCC
This is a challenging question and dilemma. There are those pathologists who refuse to use the term KA anymore and only will state that the lesion is well differentiated SCC with keratoacanthomatous pattern and then suggest clinical correlation. A KA by history is a very fast growing lesion with a central keratin plug, often growing to a dramatic size in only several months. With this history, the proper location, and a mutual understanding between doctor and patient an aggressive curettage can be appropriate treatment in many locations. What concerns me is the recent path report finding residual tumor in the deeper cuts. As a Mohs surgeon of over 30 years I am partial to chasing the tumor with Mohs and dealing with the defect either on my own or in consulation with a facial plastic surgeon who I work with almost exclusively. Yes a forhead flap may be necessary, but it is best not to plan for the worse when something simpler will work just as well with less recovery and down time. Take those path reports, and possibly even the slides and go get a second and even a third opinion.
Keratocanthoma is not an invasive SCC
Keratocanthoma is not an invasive SCC. Though pathologists will read the slide as an SCC it is NOT the same thing at all and does not need the excessive treatment that an invasive SCC does. I would, quite frankly, ask for copies of your biopsy report and head to at least a couple of other dermatologist surgeons for evaluations. In most cases I would treat your Keratocanthoma with a currette and evaluate again in a few months. I would do none of the things you have described to treat Keratocanthoma. And I've been doing Mohs and large dermatology reconstructive procedures for almost 30 years.
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