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Impact of Immediate Surgical Reconstruction Following Wide Local Excision of Malignant Melanoma

Ah Lee, Seung MD; Hu, Allison C. BA; Evans, Gregory R. D. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 65
doi: 10.1097/01.GOX.0000584584.50444.f4
Craniofacial Abstracts
Open

University of California, Irvine, Orange, CA

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: The role of surgical reconstruction following melanoma extirpation is well recognized. Although technical considerations, such as reconstruction modality, are largely dependent on individual anatomy and surgeon preference, the optimal timing of surgical reconstruction remains unclear. Therefore, the purpose of this study was to evaluate clinical and oncologic outcomes in patients undergoing malignant melanoma extirpation followed by immediate surgical reconstruction.

METHODS: We retrospectively identified patients who underwent immediate surgical reconstruction following wide local excision of biopsy-proven malignant melanoma of the head and neck at our institution between January 2013 and December 2016. Patients were excluded if final pathology demonstrated nonmelanoma histology or if reconstruction was not performed by plastic surgery. Patient demographic and clinical characteristics, operative variables, and relevant outcome data were collected from patient records. Descriptive statistics were summarized and chi-square tests were used for bivariate analysis in SPSS.

RESULTS: In the duration of this study, 197 patients (139 males, 70.6%) underwent wide local excision followed by immediate surgical reconstruction. The mean age of patients at the time of surgery was 67.3 years (range, 16–95 years). Of the 70 patients with a history of cutaneous malignancy, 46 (65.7%) had a prior melanoma and 26 (37.1%) patients had ≥2 types of skin cancers, including melanoma and nonmelanoma histology. Of the 202 lesions that were resected, 138 (68.3%) were invasive (T1–T4) and 64 (31.7%) were clinically determined to be melanoma in situ (Tis) following initial biopsy. The most frequent anatomic location involved was the cheek (69, 34.2%), followed by the scalp (63, 31.2%), ear (19, 9.4%), nose (16, 7.9%), temple (16, 7.9%), and forehead (14, 6.9%). Surgical reconstruction technique varied considerably in this cohort, with 34 (15.2%) lesions repaired by complex primary closure, 132 (58.9%) by adjacent tissue transfer, 39 (17.4%) by full thickness skin graft, and 19 (8.5%) by split thickness skin graft. On postoperative pathologic assessment, 21 (10.7%) lesions were upstaged and 2 (0.9%) were found to have positive margins. The mean follow-up time following surgical reconstruction was 2.3 years (SD, 1.4 years). Overall, 5 patients experienced local recurrence during the follow-up period, with a mean time to recurrence of 7.6 months (range, 1.8–13.0 months). In an unadjusted bivariate analysis, history of melanoma (P = 0.015) was significantly associated with local recurrence following resection.

CONCLUSION: Surgical reconstruction at the time of wide local excision is a safe and oncologically sound approach for the surgical management of patients with malignant melanoma. A prior history of melanoma may be associated with recurrence.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.