Introduction. Basal cell carcinoma is the most common malignant cutaneous neoplasm and accounts for most non-melanoma skin cancers. Despite its low metastatic potential, it may exhibit locally aggressive behavior, particularly in high-risk anatomical regions such as the nose and in aggressive histological subtypes, including the micronodular variant. Involvement of the nasal ala represents a significant therapeutic challenge, as management must integrate the principles of complete oncologic resection with optimal functional and aesthetic reconstruction. In this context, local flaps represent a valuable reconstructive option, and the bilobed flap remains a reliable technique for small to medium-sized nasal defects due to its versatility, favorable tissue match, and ability to achieve reconstruction in a single surgical stage. Objective. To describe the diagnostic approach, surgical management, and immediate reconstruction of a micronodular basal cell carcinoma located on the left nasal ala, as well as to highlight the utility of the bilobed flap as a reconstructive option for nasal defects following oncologic resection. Materials and Methods. A 54-year-old female patient is presented, with a history of systemic arterial hypertension, chronic occasional tobacco use, and prior superficial parotidectomy for benign disease, who presented with a dermal lesion on the left nasal ala of one year’s duration with progressive growth. On physical examination, a nodular lesion measuring approximately 1 cm was identified, with poorly defined borders, pigmentation, and central ulceration, without evidence of deep tissue invasion. An incisional biopsy was performed on October 10, 2025, yielding a histopathological diagnosis of ulcerated, pigmented micronodular basal cell carcinoma. Given the high-risk histological subtype and the anatomical location, surgical treatment was indicated. A wide three-dimensional excision with 1 cm safety margins was performed, followed by immediate reconstruction using a bilobed flap designed according to nasal subunit principles. The procedure was completed without complications, and the flap demonstrated adequate viability in the immediate postoperative period. Results. During the surgical procedure, an exophytic nodular lesion measuring approximately 1 cm in diameter was identified on the left nasal ala. A wide three-dimensional excision was performed, with adequate circumferential and deep margins to ensure optimal oncologic control. The resulting defect was immediately reconstructed using a bilobed flap, allowing coverage with local tissue of similar characteristics, appropriate redistribution of tension, and preservation of the nasal contour. In the immediate postoperative period, the patient remained hemodynamically stable, with a Glasgow Coma Scale score of 15, fully oriented, without evidence of active bleeding, and with adequate flap viability, with no immediate complications. Conclusions. Micronodular basal cell carcinoma located on the nasal ala represents a high-risk entity due to both its anatomical location and its infiltrative histological pattern, requiring a surgical approach with strict adherence to oncologic principles. Wide three-dimensional excision followed by immediate reconstruction using a bilobed flap constitutes a safe and effective option in selected cases, as it allows adequate tumor control while achieving functional and aesthetic restoration in a single surgical stage. In this context, the bilobed flap remains a valuable reconstructive tool in facial plastic surgery, particularly for small to medium-sized defects of the distal nasal third.
Rodríguez-Enríquez et al. (Wed,) studied this question.