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Identification of High-Risk Lesions and Selection of Method of Reconstruction

Robert M. Bumsted, MD; Roger I. Ceilley, MD

Arch Otolaryngol. 1982;108(4):225-231.

Abstract
• A prospective study of 71 auricular malignant neoplasms was conducted comparing recommended margins for conventional surgical excision to the actual margins obtained after microscopically controlled excision (Mohs' chemosurgery technique) to identify lesions at high risk for inadequate excision with conventional excision. High-risk lesions included all tumors larger than 1 cm, morpheaform basal cell carcinoma, and multiply recurrent lesions of any size. Successful excision by conventional surgery would have resulted in a defect notably larger than the actual Mohs' defect in all cases. The excess tissue excised by conventional surgery averaged 180% larger than the actual defect in primary lesions and 347% larger in recurrent lesions. Methods of reconstruction used include the following: secondary intention (granulation), primary closure, skin grafts, local flaps, and meatoplasty. The incidence, indications, and usual results obtained are discussed in detail. Mohs' chemosurgery technique provides substantial benefit and should be considered in all recurrent lesions and primary lesions larger than 1 cm to reduce recurrence and minimize the resultant deformity.

(Arch Otolaryngol 1982;108:225-231)

Author Affiliations
From the Departments of Otolaryngology and Maxillofacial Surgery (Dr Bumsted) and Dermatology (Dr Ceilley), University of Iowa Hospital and Clinics, Iowa City.

Footnotes
Accepted for publication Aug 5, 1981.

Read before the American Academy of Facial Plastic and Reconstructive Surgery, Vancouver, British Columbia, May 13, 1981.

Reprint requests to the Department of Otolaryngology and Maxillofacial Surgery, University of Iowa Hospital and Clinics, Iowa City, IA 52242 (Dr Bumsted).

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