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The Role of Full-Thickness Scalp Resection for Management of Primary Scalp Melanoma

Pannucci, Christopher J. MD, MS*; Collar, Ryan M. MD; Johnson, Timothy M. MD; Bradford, Carol R. MD§; Rees, Riley S. MD

doi: 10.1097/SAP.0b013e31822592e7
Head and Neck Surgery

Background Scalp melanoma is aggressive and has a proclivity for regional metastasis. We hypothesize that subperiosteal scalp melanoma resection reduces in-transit/satellite recurrence, when compared with subgaleal resection.

Methods We identified patients with intermediate to deep, primary scalp melanoma referred to head/neck surgery over an 8-year period. Patients were compared based on scalp resection depth, including subperiosteal (resection to the level of calvarium) and subgaleal (resection including skin, subcutaneous tissue, and galea). The dependent variables were in-transit/satellite recurrence and time to in-transit/satellite recurrence.

Results Among 48 identified patients, the in-transit/satellite recurrence rate was 16.7%. Subgaleal resection patients had higher in-transit/satellite recurrence rates than subperiosteal resection patients (24.0% vs. 8.7%, P = 0.155). Among node-negative patients, subgaleal resection had significantly higher in-transit/satellite metastasis rates when compared with subperiosteal resection (26.3% vs. 0%, P = 0.047).

Conclusion For node-negative, primary scalp melanoma, subperiosteal resection significantly decreases in-transit/satellite recurrence when compared with subgaleal resection. Given our small sample size, further studies are necessary to confirm these results.

From the *Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan; †Departments of Otolaryngology, ‡Dermatology, and §Otolaryngology, University of Michigan, Ann Arbor, Michigan; and ¶Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan.

Received February 17, 2011, and accepted for publication, after revision, May 20, 2011.

Conflicts of interest and sources of funding: Supported through salary (NIH grant T32 GM-08616) (to C.J.P).

Dr. Pannucci and Dr. Collar contributed equally to this manuscript and are co-first authors.

Reprints: Riley S. Rees, MD, Section of Plastic Surgery, Department of Surgery, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48105. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.