Determinants of Postoperative Scar Quality After Nasal Basal Cell Carcinoma Surgery: The Predictive Value of Topographic Subunit and Reconstruction Technique

Reconstruction of nasal defects after basal cell carcinoma (BCC) excision must restore the contour and skin quality across topographic subunits that differ in thickness, sebaceous quality, and mobility. The authors evaluated the early postoperative scar quality and its association with nasal location, subunit burden, and reconstruction technique. In this single-center study, 156 consecutively enrolled patients with histologically confirmed nasal BCC were assessed 3 months postoperatively. Two independent blinded observers rated the Manchester Scar Scale (MSS; intraclass correlation coefficient for the mean of 2 observers: 0.943), and the operating surgeon rated a 10-cm Visual Analog Scale (VAS). Lower-nose involvement was independently associated with worse scars (MSS β=1.80; 95% CI: 0.93–2.66), as was involvement of 3 or more subunits (β=2.85; 95% CI: 1.11–4.59). A 3-region analysis showed graded worsening from upper-only to mixed and lower-only defects. Full-thickness skin grafting showed a small, texture-driven MSS advantage over flaps in the primary model (β=−0.83) that was not reproduced in robust or median regression or in VAS and is therefore regarded as exploratory and confounded by indication. Nasal topography and the extent of subunit involvement, rather than the reconstruction technique, were the dominant correlates of early scar appearance and should inform reconstructive planning and preoperative counseling.