\s=b\Standard methods of managing large or recurrent cutaneous nasal malignant neoplasms are often inadequate, leaving extensions of the tumor that are clinically invisible. Conventional methods may also allow considerable amounts of normal tissue to be sacrificed in an attempt to ensure the removal of all carcinoma.Through partnership of the dermatologic surgeon and the reconstructive surgeon, a more effective method of curing and rehabilitating patients with nasal skin cancer can be achieved. The dermatologic Mohs' surgeon can perform microscopically controlled excision of malignant neoplasms, providing the highest cure rates obtained by any method. This method is particularly suited for basal cell carcinomas that are recurrent, larger than 1 cm in size, or are of the morpheaform histologic subtype. Total microscopic excision allows nasal reconstruction to proceed with the highest degree of confidence of tumor control. The location and extent of the malignancy dictate the surgical approach for nasal reconstruction. (Arch Otolaryngol 1983;109:473-479) Skin cancer is the most common form of malignancy in man. The nose is the most common site of skin cancer and also is one of the most difficult areas on which to effect a cure. A recent review of 2,600 patients with cancer of the skin of the head and neck area demonstrated that bas¬ al cell carcinoma was the predomi¬ nant histological type (69%). Approx¬ imately 12% of the patients had can¬ cers of the nasal skin.1 Of the 305 patients with a nasal skin cancer, only 64% of the tumors were confined strictly to the skin of the nose. Approximately 40% of all recalci¬ trant basal cell carcinomas of the head and neck involve nasal skin.2 This is, in part, related to multiple embryologie fusion planes occurring in the nasal region that offer paths of decreased resistance to the spread of neoplasm.3 Conventional methods of managing nasal cutaneous malignant neoplasms included electrodesiccation and curettage, cryosurgery, radiotherapy, and surgical excision. Electrodesiccation and curettage and cryosurgery are acceptable methods of managing small tumors less than 0.5 cm in diam¬ eter. However, they are not as effec¬ tive for larger tumors and other modalities should be used.Radiotherapy offers a high cure rate for basal cell and squamous cell carcinomas of the nasal skin. Surgical excision is also a good method for small cutaneous malignant neoplasms of the nose where flaps and grafts are required for closure. More extensive tumors treated with surgery should make use of an extended follow-up period of six to 12 months before reconstructive procedures are initi¬ ated.Another method of managing nasal cutaneous malignant neoplasms is by microscopically controlled excision (Mohs' surgery). The cornerstone of this surgical method is total micro¬ scopic control of excision. Using local Downloaded From: http://archotol.jamanetwork.com/ by a Oakland University User on 05/31/2015