Malignancies of the Nose Vestibule: Salvage Strategies

While evidence concerning the effectiveness of IRT in the treatment of the local lesion in nose vestibule SCC already supports its acceptance as a new standard for primary (previously untreated cases), the same evidence is lacking in case of recurrence, especially if the patient has already been irradiated. Therefore, surgical treatment after recurrences in nasal vestibule cancers, which is reported to increase local control of the disease up to 96%, remains the standard in these cases, and it is worthwhile, whenever possible. While the surgical strategy is straightforward in case of neck recurrence, it poses unique problems in terms of demolition and reconstruction at the level of T, owing to the complex anatomy of the area and to the pattern and location of the recurrence. The options for salvage treatment and in particular for salvage surgery are discussed in this chapter, with regard to the preoperative evaluation and surgical planning, based on the subunits of the nasal vestibule and an accurate evaluation of the extent of the lesion. The issue of timing of the reconstructive phase is discussed as well as the influence of previous treatments on the availability of different surgical options. Finally, available reconstructive techniques are described.