Publication:

Oncological treatment and upper lip reconstruction in basal cell carcinoma: case report and review of reconstructive options

Basal cell carcinoma (BCC) is the most common cutaneous malignancy and frequently affects sun-exposed facial regions. Lesions of the upper lip are considered high risk due to their tendency for local invasion, recurrence, and involvement of critical functional and aesthetic subunits. Optimal management requires complete oncologic excision followed by anatomically precise reconstruction.  We report the case of a 66-year-old woman with a recurrent nodular BCC of the upper lip after prior incomplete excision. Margin-controlled surgical resection was performed with intraoperative frozen-section analysis. Persistent deep margin involvement required extension of the excision to include the upper lip, anterior nasal vestibule floor, and premaxillary periosteum, resulting in a defect involving approximately 40% of the upper lip. Immediate reconstruction was carried out using a layered anatomical approach, including separate repair of the mucosa and orbicularis oris muscle, bilateral perialar advancement flaps, and an additional local cutaneous flap to reconstruct the central tubercle. This case highlights the importance of achieving complete tumor clearance in recurrent BCC, particularly in high-risk anatomical regions such as the upper lip. Reconstructive planning must balance oncologic safety with restoration of oral competence, symmetry, and aesthetic subunits. Local advancement flaps, especially perialar techniques, represent reliable options for moderate defects (30–50%), providing good functional and cosmetic outcomes when combined with meticulous layered repair. The presence of recurrence and periosteal involvement underscores the need for multidisciplinary evaluation, including consideration of adjuvant therapies. Recurrent upper-lip BCC requires an integrated approach combining aggressive oncologic resection with tailored reconstruction. Layered repair and local advancement flaps allow effective restoration of both function and aesthetics in moderate-sized defects, supporting their role as first-line reconstructive options in appropriately selected cases.