My husband was diagnosed by a dermatologist with Basal Cell Carcinoma on the tip of his nose and was subsequently referred to a plastic surgeon for removal of it. Surgery was performed 11/2010. His nose is now terribly scarred. WADSC surgery was performed with an excision from nasal tip of approx. 13 x 17mm. Results of the biopsy were that there was no residual evidence of previously diagnosed BCC. Evidently the dermatologist got it all with his initial biopsy. At my suggestion, my husband did ask the surgeon if it was possible the dermatologist got it all and the surgeon seemed put off by the suggestion as though he knew what he was doing. The surgeon then performed a Superiorly Based V-Y Advancement Flap. My question is, was this level of invasive surgery even necessary? Is it customary to do all this with the end result being the dermatologist got it all with his initial biopsy? Also, given the size of the surgeon s excision, would it have been more appropriate for him to perform just a skin graft as opposed to a flap procedure? Of additional consideration: My husband is a smoker and was not told to cease smoking prior to the surgery. Wouldn t this have been prudent preoperative advice? Should they have performed a flap surgery knowing he was an active smoker? Thank you.