The use of forehead flaps in the management of large basal cell carcinomas of the medial canthus/medial lower eyelid in Saudi patients

Purpose: Basal cell carcinoma (BCC) is the most common skin cancer worldwide. BCC represents 90–95% of all malignant eyelid tumors with lower eyelid/medial can thus lesions being more common than lower eyelid/lateral can thus lesions. Although various local flaps have been used for the reconstruction of medial canthus/adjacent eyelid defects, we find the forehead flap to be themost suited for these cases. Materials and methods: We are reporting a clinical series of BCC involving the medial can thus and adjacent medial lower eyelid through a retrospective review of 18 patients who underwent surgical excision of the lesion followed by primary reconstruction using forehead flaps. Patients who underwent reconstruction without forehead flaps were excluded. All cases were Saudis and underwent this type of reconstruction. Indications, results, and complications were reviewed with special emphasis on the acceptance of the obvious forehead donor site scar in Saudi patients. Results: All flaps survived completely Follow-up ranged from 2 to 10 years (mean of 5 years). Tumor recurrence was not seen in any of the patients. Functionally, there was no ectropion and the eyelid margin was well aligned and stable. However, epiphora was evident since lacrimal system reconstruction was not performed. Conclusion: We are presenting the first Saudi series of large medical canthus/lower eyelid defects that underwent reconstruction using forehead flaps. The outcome was satisfactory and there were no cases of tumor recurrence. The only disadvantage is the donor scar which seems to be acceptable in the Saudi population because of their traditional head cover.