BASAL-CELL CARCINOMA OF THE NOSE

The purpose of this study of 81 patients with basal cell carcinoma (BC C) of the nose was to present the oncological and cosmetic results of surgical treatment and compare these results with those of other possi ble treatments. Material and Method. We report a series of 81 cases of histologically proven BCC of the nose located chiefly on the alae nas i and on the lower end of this organ; 42 p. 100 of the tumors had prev iously been treated and had recurred. The patients' mean age was 63 ye ars, and the shortest follow-up was 3 years. Excision of the tumor und er simple or reinforced local anaesthesia was complete in 88 p. 100 of the cases, incomplete or borderline in 12 p. 100 and systematically r epeated. Extemporaneous histological examination was performed in 18 p . 100 of the cases. The operative lesion was repaired with a graft or a flap. There was no postsurgical treatment. Results. The recurrence r ate was 4 p. 100 with a minimum follow-up of 3 years. The comestic res ult was good in 78 p. 100 of the patients. Discussion. Numerous treatm ents have been used against BCC of the nose, the results, advantages a nd disadvantages of each of these treatments are given below: 1. Cryos urgery. The problem with this method is that it is relatively difficul t to perform and requires reliable operators. The cure rate is similar to that of other treatments (3, 10, 26). 2. Chemotherapy is not frequ ently used. 3. Electrocoagulation. Contrary to the conventional excisi on, this method precludes all histological controls, and the common id ea of good oncological results is now being revised (8, 15, 20). 4. Ra diotherapy. The recurrence rate varies from 7 to 11.8 p. 100 (8, 17) w ith fair cosmetic results. It requires numerous sessions, cannot be re peated in case of recurrence and complicates the surgical treatment. I n addition, there is a long-term risk of radiodystrophy. 5. Curiethera py by local implantation of Iridium-192 has a recurrence rate of 2.5 t o 7 p. 100 (17). This treatment requires hospitalization and is costly . It is indicated in cases of complex surgery, difficult conventional radiotherapy and above all, sclerodermatous BCC. 6. Surgery has a recu rrence rate which varies from 3.7 to 12.6 p. 100 (8, 18, 24). Recurren ces are due to insufficient excision, and this underlines the value of histological control which can be done only at surgery. It is a rapid and ambulatory treatment, usually performed under local anaethesia. T he cosmetic result is good (85 to 90 p. 100) and the patients must be made aware of this preoperatively with some degree of reliability, dep ending on age, location, size of BCC and on the surgical technique uti lized. Conclusion. Surgical treatment of nasal BCC is safe, effective and rapid, with good oncological and cosmetic results, and it has many advantages over the other treatments.