Multivectorial reconstructive surgical approaches in basal cell carcinoma and trichoscopy application in alopecia mucinosa: an integrative and systematic technical analysis

Abstract

Contemporary dermatology operates at a critical intersection between high-precision oncological surgery and advanced clinical propaedeutics, requiring the specialist to possess technical mastery that transcends conventional practice. This technical study performs an integrative and systematic analysis intended to serve as an educational benchmark for specialized practice, correlating three fundamental pillars of therapeutic excellence. In the surgical realm, the reconstruction of large defects following Basal Cell Carcinoma (BCC) excision using the Triple Rhomboid Flaptechnique is deeply examined. The biomechanics of vector tension distribution in a "pinwheel" configuration is discussed, demonstrating how this geometric approach offers hemodynamic superiority and prevents distal ischemia in areas of low skin compliance. In the diagnostic scope, the analysis focuses on the complexity of Alopecia Mucinosa, highlighting trichoscopy not merely as a complementary exam, but as an indispensable tool for identifying specific vascular and follicular patterns essential for the early distinction between benign forms and cutaneous T-cell lymphoma. Finally, the study repositions Psoriasis as the paradigmatic model of precision medicine and evidence-based therapeutic innovation. It addresses how early intervention with immunobiologics within the "window of opportunity" illustrates modern dermatology's capacity to modulate the systemic immune response and alter the natural history of the disease. It is concluded that the consolidation and dissemination of these advanced clinical models are imperative to elevate standards of safety, efficacy, and replicability in national healthcare.