The Versatile Art of Reconstruction: A Decade-Long Journey with Recurrent Facial Basal Cell Carcinoma

Background: Basal cell carcinoma (BCC) is the most common skin cancer, representing about 80% of non-melanoma skin cancers. Facial BCCs, particularly infiltrative and recurrent types, present substantial challenges due to their aggressive nature and potential for local recurrence. Objective: This report highlights the surgical and reconstructive challenges in managing recurrent infiltrative BCC of the face over a decade-long clinical course, emphasizing the importance of advanced techniques and multidisciplinary care. Case Presentation: A 78-year-old female first presented in 2013 with an infiltrative BCC on the left anterior chin. Initial treatment involved wide local excision (WLE) and adjuvant radiotherapy, yet the carcinoma recurred. Subsequent recurrences occurred in December 2017 and January 2021, with the latest recurrence in 2023 presenting as a 1 cm lesion at the chin more on the left , accompanied by facial asymmetry and lip drooping due to scar contracture. Surgical Technique: The resection involved extensive removal of the lower lip, exposing the mandible. Reconstruction utilized bilateral Karapandzic flaps for the lower lip and a bilobed rotational flap for the chin defect. Meticulous dissection preserved vital neurovascular structures, ensuring functional and cosmetic restoration. Outcome: Post-operative histology revealed basal cell carcinoma with squamous differentiation, clear margins, and no invasion. The patient showed satisfactory recovery, with functional and aesthetic outcomes meeting expectations. She remains disease-free 18 months post-surgery. Conclusion: This case underscores the complexities in managing recurrent facial BCCs and the necessity for advanced surgical techniques and a multidisciplinary approach to achieve optimal outcomes.