Hu Allison C, Lee Seung Ah, Clark Emily G, Yamamoto Maki, Jakowatz James G, Evans Gregory R D
Department of Plastic Surgery, University of California, Irvine, Orange, Calif.
Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Orange, Calif.
Plast Reconstr Surg Glob Open. 2020 Feb 24;8(2):e2661. doi: 10.1097/GOX.0000000000002661. eCollection 2020 Feb.
The role of surgical reconstruction following melanoma extirpation is well recognized. Although technical considerations depend on patient anatomy and surgeon preference, the optimal timing of reconstruction remains unclear. This study aims to evaluate clinical and oncologic outcomes in melanoma extirpation followed by immediate reconstruction.
We retrospectively identified patients who underwent immediate reconstruction following head and neck melanoma excision at our institution between January 2013 and December 2016. Demographic and clinical characteristics, operative variables, and outcome data were extracted.
Overall, 197 patients (male 70.6%) underwent excision followed by immediate reconstruction. Of the 70 patients with a history of cutaneous malignancy, 46 (65.7%) had a prior melanoma and 26 (37.1%) had 2 or more types of skin cancers. Of the 202 lesions resected, 138 (68.3%) were invasive, whereas 64 (31.7%) were in situ. The most frequent anatomic location involved was the cheek (34.2%), followed by scalp (31.2%). Reconstruction technique varied, with 116 (57.4%) lesions repaired by adjacent tissue transfer, 24 (11.9%) by full-thickness skin graft, 23 (11.4%) by complex primary closure, 17 (8.4%) by split-thickness skin graft, and 22 (10.9%) by more than 1 technique. On postoperative pathologic assessment, 2 patients had positive margins and 5 experienced local recurrence (mean follow-up: 2.3 years). In an unadjusted bivariate analysis, history of melanoma ( = 0.015) was significantly associated with local recurrence.
Reconstruction at time of excision is an oncologically safe approach for the management of patients with malignant melanoma. A prior history of melanoma may be associated with local recurrence.
黑色素瘤切除术后手术重建的作用已得到充分认可。尽管技术考量取决于患者解剖结构和外科医生的偏好，但重建的最佳时机仍不明确。本研究旨在评估黑色素瘤切除术后即刻重建的临床和肿瘤学结局。
我们回顾性确定了2013年1月至2016年12月在我院接受头颈部黑色素瘤切除术后即刻重建的患者。提取了人口统计学和临床特征、手术变量及结局数据。
总体而言，197例患者（男性占70.6%）接受了切除术后即刻重建。在70例有皮肤恶性肿瘤病史的患者中，46例（65.7%）曾患黑色素瘤，26例（37.1%）患有2种或更多类型的皮肤癌。在所切除的202个病灶中，138个（68.3%）为浸润性，而64个（31.7%）为原位癌。最常累及的解剖部位是脸颊（34.2%），其次是头皮（31.2%）。重建技术各不相同，116个（57.4%）病灶通过邻近组织转移修复，24个（11.9%）通过全厚皮片移植，23个（11.4%）通过复杂的一期缝合，17个（8.4%）通过中厚皮片移植，22个（10.9%）采用了不止一种技术。术后病理评估显示，2例患者切缘阳性，5例出现局部复发（平均随访时间：2.3年）。在未经调整的双变量分析中，黑色素瘤病史（P = 0.015）与局部复发显著相关。
切除时进行重建对于恶性黑色素瘤患者的治疗是一种肿瘤学上安全的方法。黑色素瘤既往史可能与局部复发有关。
