The main issue concerning periorificial non melanoma cancer of the nose is classification, several inconsistencies and inadequacies of AJCC site definition and TNM staging need to be addressed.
In the “periorificial area” there are true skin lesions, usually arising away from the mucocutaneous junction, for which the general considerations concerning cancers of the skin are in general valid, and there are tumors of the muco-cutaneous junction and in particular of the nose vestibule with many often underestimated but nevertheless critical peculiarities.
For “true” skin cancers, in the absence of serious reconstructive concerns surgery remains the primary option.
For nose vestibule tumors which are put by AJCC together with posterior nasal cavity and ethmoid malignancies, TNM classification is clearly inadequate, as the most ominous finding, which is bone invasion, does not even make for a T2, while the constant feature of skin involvement, which is not an issue under an oncological point of view, always determines an upstaging to cT4. In these cases the Wang classification for T works much better.
Another peculiarity of such lesions is the very easy surgical resection alongside the frequent impossibility to obtain a satisfactory reconstruction. This feature, together with very low toxicity, easy implantation and resistance of cartilage to irradiation if the implants are “anatomic” (without piercing of the perichondium), makes brachytherapy the standard treatment for non-previously irradiated primary SCCs of the vestibule.
Preliminary evidence and personal experience show promising results with brachytherapy also for BCC.
Surgery remains the most validated option for nose vestibule primaries infiltrating the bone (T3 according to Wang classification) and for recurrences after irradiation.