Management of basal cell carcinoma at

forehead with excision and closure defect

Flap-H
PATHOGENESIS
 Pluri Potential cells in the stratum basalis
develop continously
Generally derived from the epidermis and can
also from the hair follicle root shell
Carsinogens are a gradual and complex process
of accumulation of genetic changes
Ultraviolet radiation has a relationship in the
pathogenesis of skin cancer
Ultraviolet radiation destroys DNA and produces
Dimer cylobutame-type piramidin (cpd),
pyramidine (6-4), derivat (6-4) photoproduct
 Management

Curettage
Electrodesiccation
Excisional surgery
Radiotherapy
Cryosurgery
Mohs micrographic surgery
New treatment combined fluorouracil 5 with
curettage
 prognosis
BCC is very easy to recurrence, so the right
action really determinens the prognosis.
The purpose of surgical excision at BCC by
removing the entire mass of the tumor with a
minimum of slices or good result
 Excision surgery is a surgery that uses
reconstruction to form a Flap.
The H-flap technique is a simple flap technique
that is easy to do with satisfaisctory results. H
flap is often used to cover simple linear
defects and form a bilateral rectangular
pedicle. This flap technique varies greatly
based on local flap movement divided over
linear and protational (pivotal)
 Flap advencement is a kind of linear flap by
moving the adjacent skin perpendiculary to
close the defec, by direct shifting over the
defect. Its function of moving the excision line
becomes more hidden so more cosmetic.
 Examination
Physical examination:
KU : good
TD :120/80 mmhg
HR :80 x/i
RR :20 x/i
T :36,80 C
Dermatology examination:
the found ulcer of size 2,5 cm x 1,5 cm which has been
bleeding, skuama smooth and crusta thin on the frontalis
region.
 Tindakan
Bleeding is stopped using pressure with steril gauze
Wound sewn dlawall subcuticular sutures using silk
3-0 so that proceeded epiderma stitch using nylon 5-
0 so that touch H-flap
Which has been sewn smeared antibiotic ointment
and then closed using sterilegauze and plaster.
patients of General condition good post-operationt
 CONT
Patients are given treatment systemic
cefadroxyl antibiotics 2x500 mg/day,
mefenamic acid 3x500mg/day, and natrium
fusidate ointment post-operation.
Excised tissue is sent to pathology for
histopatological examination.
 Cont
On the 3rd day of the day, the treatment was given
cefadroxyl 2x500 mg/day, mefenamic acid
3x500mg/day (if still pain) , and natrium fusidate
ointment
At the 7th day of control dry wound was performed
the opening of therapy suture in the form of natrium
fusidate ointment.
After 2 months later the wound looks better and after
12 months the patien comes back the skin on the
wound look getting better, signs of recurrens are not
visible. The wound shows satisfactory result.
Prognosis in this case is good.
 histopatological examination result

There appears an irregular mass preparation

of basaloid cells formed in the dermis with the
uppermost cells,
Forming a palisade layer at the edges,
The surrounding stroma exhibiting a fibrous
reaction
 Conclusion
Dignosis :
Basal cell carsinoma ulcerative nodules