High-Risk Basal Cell Carcinomas of the Head and Neck: Selected Successful Surgical Approach in Three Bulgarian Patients!

Background: Regarding localisation, basal cell carcinomas are classified in three risk groups, designated as H for high-, M as medium-, and L as low-risk area. In patients with high-risk basal cell carcinomas (BCCs), as a first-line of treatment are mentioned, different types of surgical approaches and radiotherapy. Depending on the location of the tumour, the choice of surgical technique should vary and be consistent with the patient's will for a most aesthetically acceptable result.

Case Report: Three cases of patients with BCCs defined as high-risk about two different indicators-localisation and relapse after radiation therapy are presented. For the recovery of the occurred defects, three different types of surgical approaches (primary closure/undermining surgical approach, island flap and advancement flap) were used, tailored to the high-risk factors in each patient, which at the same time provided a perfect clinical outcome.

Conclusions: High-risk BCCs are a challenge for every dermatosurgeon and require serious training and knowledge both in terms of anatomy and in terms of the possibilities for reconstruction of the defects that occurred. Operations usually run in three phases, namely: 1) removal of tumour tissue, 2) intraoperative plan for reconstruction according to the size of the defect and the condition of the surrounding tissues as well as phase 3) undermining of surrounding tissues and adaptation of the wound edges.