438502.fig.003a
(a)
438502.fig.003b
(b)
438502.fig.003c
(c)
438502.fig.003d
(d)
Figure 3: (a) a 65-year-old male status after Moh’s resection for lentigo maligna melanoma in the right lower lid, cheek, and lateral nasal wall. The defect measured 5 cm by 4 cm. (b) It was decided to decrease the size of the defect using adjacent tissue flaps prior to considering use of a skin graft. Alternatively, a skin graft could be placed for the entire defect; however, it is our preference to use adjacent tissue whenever possible. An infraciliary incision with nasolabial extensions allows for the lateral midface and cheek to be rotated medially and superiorly to fill approximately 60% of the wound (straight arrow). In addition, this keeps the tension horizontal rather than vertical. A rhomboid flap is raised superiorly and rotated inferiorly to fill in the superior aspect of the wound (curved arrow). (c) A full thickness skin graft from the inner upper arm is used to fill in the remaining wound (arrow). (d) Eleven months postoperatively showing mild residual ectropion of right lower lid.