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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2025, vol. 31, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2025313.6418
Published online: 21 August 2025
Case report
J of IMAB. 2025 Jul-Sep;31(3):6418-6422
ARTIFICIAL INTELLIGENCE DERMOSCOPY AND A-T ADVANCEMENT FLAP FOR BASAL CELL CARCINOMA OF THE SCALP
Preslav Vasilev1
, Dragomir Bogdanov2, Sibel Ramadan3, Martin Karamanliev4, Dobromir Dimitrov4,
1) Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University – Pleven, Bulgaria.
2) Sixth-year medical student, Faculty of Medicine, Medical University – Pleven, Bulgaria.
3) Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University – Pleven, Bulgaria.
4) Surgical Oncology Department, University Hospital “Dr. Georgi Stranski”, Faculty of Medicine, Medical University-Pleven, Bulgaria.
ABSTRACT:
Purpose: Basal cell carcinoma of the skin often affects the head and neck area. In elderly male patients with androgenic alopecia, the scalp is a zone of cancerization, often suffering from keratinocyte tumors. After surgical excision, extensive round and oval defects are common, and in these cases, reconstructive surgery is needed. This is a serious challenge for dermatosurgeons, surgical oncologists and reconstructive surgeons since the scalp has limited skin mobility and the skin elasticity decreases with age. Multiple graft and flap techniques have been described, and they often lead to long scars and edge necrosis.
Material/Method: We present a 74-year-old patient diagnosed with basal cell carcinoma affecting the frontal region of the middle scalp line with a diameter of 35mm. Artificial intelligence dermoscopy was performed with a 95% malignancy rate. The lesion was excised with a safety peripheral zone of 6mm from the dermatoscopically visible edges on each side, creating a defect with diameter of 50 mm, reaching in depth to the galea aponeurotica. A-T advancement flap was performed for reconstruction of the defect with a satisfactory functional outcome.
Results: In the follow-up period, there was no bleeding, necrosis, or other complications. We assessed optimal functional and cosmetic postoperative effect.
Conclusion: In the literature, a variety of procedures for scalp reconstruction have been described. In patients with extensive tissue loss, advancement flaps, like the A-T flap, are most commonly used. This advancement flap technique is practical and safe with good structural and aesthetical effect.
Keywords: Basal cell carcinoma, Skin defect, A-T advancement flap, reconstruction,
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Please cite this article as: Vasilev P, Bogdanov D, Ramadan S, Karamanliev M, Dimitrov D. Artificial intelligence dermoscopy and A-T advancement flap for Basal cell carcinoma of the scalp. J of IMAB. 2025 Jul-Sep;31(3):6418-6422. [Crossref - 10.5272/jimab.2025313.6418]
Correspondence to: Preslav Vasilev, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University – Pleven; 1, Sv. Kliment Ohridski Str., 5800 Pleven, Bulgaria; E-mail: preslav.vasilev@abv.bg
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Received: 04 March 2025
Published online: 21 August 2025