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Nasal Reconstruction

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  • Interesting Case Series
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EPLASTY-IC-REISLER.dvi Interesting Case Series Nasal Reconstruction Tom Reisler, BSc(Hons), MB ChB, MRCS(Ed),a Margaret H. Mysliwiec, MD,b and Gregory L. Borah, MDa aDivision of Plastic Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA, and bDepartment of Medicine, University Hospital and New Jersey Medical School, Newark, NJ, USA Correspondence: [email protected] Figure 1. An old photograph before developing the nasal deformity (left); recent preoperative photograph (right). DESCRIPTION A 55-year-old man comes to the office for consultation regarding a gradually enlarging lesion on his nose, and nasal airway obstruction. This has developed over several years. Physical examination shows enlargement of the nose, pitting and scarring of the skin, and several irregular and nodular growths (Fig 1). QUESTIONS 1. What is the diagnosis? 2. What disease causes this condition? 3. What is the association of skin cancer with this skin condition? 4. What is the most appropriate management? DISCUSSION The patient has rhinophyma, or sebaceous hyperplasia of the nasal skin. Rhinophyma is believed to be the fourth stage of evolving rosacea. It is the proliferative phase that develops after acne rosacea. Patients have a predisposition to increased facial vascularity that can result in prerosacea or frequent facial flushing, vascular rosacea with erythrosis and telangiectasias, followed by inflammatory rosacea or acne rosacea, and ultimately rhinophyma.1,2 Patients typically present with nasal skin erythema and telangiectasias. In severe cases, the skin can have pits, fissures, and scarring. Sebum and bacteria can result in chronically infected skin and often an unpleasant odor. The nasal tip is preferentially enlarged, and as the nasal skin hypertrophies, the aesthetics units of the nose are distorted and obliterated.3 The skin lesions are not considered premalignant; however, a 3% to 10% incidence of occul

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