ONCOPLASTIC CONE-SHAPED REMOVAL OF MELANOMA IN SITES WITH LIMITED SKIN RESOURCES
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2022.1.13095Keywords:
skin melanoma, surgical margins, oncoplastic surgeryAbstract
Background. According to the existing recommendations of the NCCN, 2-cm margins are optimal for surgical excision of skin melanoma (SM).
Objective. A method of cone-shaped oncoplastic surgery of SM in sites with limited skin-plastic resources is presented.
Methods. In the study 30 patients (11 men, 19 women) underwent cone-shaped removal of primary SM on arm and shin, epigastria and subclavicular sites. Oncosurgical approach involves the following: primary SM is excised with 2 cm margins around with transforming this round wound into conical using additional incisions; then conical wound is closed by transverse displacement of lateral skin-fatted flap. The postoperative seam looks like hook-shaped line. SM thickness is measured by sonography before surgery. Morphological verification is obtained by cytological examination of smears after superficial scraping biopsy.
Results. Postoperative histology confirmed melanomas in all cases with “clear margins” in all surgical specimens, and postoperative staging was as follows: pT2bN0M0 – in 3 patients, pT2bN1-2M0 – 4 patients, pT3bN0M0 – 9 patients, pT4bN0M0 – 7 patients, and pT4bN1-2M0 – in 7 patients. Partial marginal necrosis of displaced flaps was of 4 patients (13.3%). There were no recurrences of melanoma at site of postoperative scar. 3-years disease free survival (DFS) rate was 76.6%, and 5 years DFS rate – 60.0%.
Conclusions. Cone-shaped radical excision of primary melanoma is an appropriate surgery for patients with SM on the forearms, shoulders, epigastria and subclavicular sites and legs. The one-step oncoplastic radical surgery without intermediate biopsy prevents local recurrence in site of surgery as well as iatrogenic metastasis to regional lymph nodes.
References
Faries MB, Mozzillo N, Kashani-Sabet M, Thompson JF, Kelley MC, DeConti RC, Lee JE, Huth JF, Wagner J, Dalgleish A, Pertschuk D. Long-term survival after complete surgical resection and adjuvant immunotherapy for distant melanoma metastases. Annals of surgical oncology. 2017 Dec; 24(13):3991-4000.
https://doi.org/10.1245/s10434-017-6072-3
Deutsch GB, Flaherty DC, Kirchoff DD, Bailey M, Vitug S, Foshag LJ, Faries MB, Bilchik AJ. Association of Surgical Treatment, systemic therapy, and survival in patients with abdominal visceral melanoma metastases, 1965-2014: Relevance of surgical cure in the era of modern systemic therapy. JAMA Surgery. 2017 Jul 1; 152(7):672-8.
https://doi.org/10.1001/jamasurg.2017.0459
Testori AA, Blankenstein SA, van Akkooi AC. Primary melanoma: from history to actual debates. Current Oncology Reports. 2019 Dec; 21(12):1-1.
https://doi.org/10.1007/s11912-019-0843-x
Gillgren P, Drzewiecki KT, Niin M, Gullestad HP, Hellborg H, Månsson-Brahme E, Ingvar C, Ringborg U. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. The Lancet. 2011 Nov 5; 378(9803):1635-42.
https://doi.org/10.1016/S0140-6736(11)61546-8
Moncrieff M. Excision margins for melanomas: how wide is enough? Lancet Oncol. 17(2) (2016):127-8.
https://doi.org/10.1016/S1470-2045(15)00556-2
Utjés D, Malmstedt J, Teras J, Drzewiecki K, Gullestad HP, Ingvar C, Eriksson H, Gillgren P. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomized trial. The Lancet. 2019 Aug 10; 394(10197):471-7.
https://doi.org/10.1016/S0140-6736(19)31132-8
Swetter SM, Thompson JA, Albertini MR, Barker CA, et al. Melanoma: Cutaneous, Version 2.2021 Featured Updates to the NCCN Guidelines. J Natl Compr Canc Netw 2021 Apr 1; 19(4):364–376.
https://doi.org/10.6004/jnccn.2021.0018
Namin AW, Zitsch III RP. Impact of biopsy modality on the management of cutaneous melanoma of the head and neck. Otolaryngology–Head and Neck Surgery. 2018 Mar; 158(3):473-8.
https://doi.org/10.1177/0194599817740568
Moncrieff MD, Gyorki D, Saw R, Spillane AJ, Peach H, Oudit D, Geh J, Dziewulski P, Wilson E, Matteucci P, Pritchard-Jones R. 1 versus 2-cm excision margins for pT2-pT4 primary cutaneous melanoma (MelMarT): a feasibility study. Annals of Surgical Oncology. 2018 Sep; 25(9):2541-9.
https://doi.org/10.1245/s10434-018-6470-1
Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ. Guidelines of care for the management of primary cutaneous melanoma. Journal of the American Academy of Dermatology. 2019 Jan 1; 80(1):208-50.
https://doi.org/10.1016/j.jaad.2018.08.055
Michielin O, Van Akkooi AC, Ascierto PA, Dummer R, Keilholz U. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2019 Dec 1; 30(12):1884-901.
https://doi.org/10.1093/annonc/mdz411
Hayes AJ, Maynard L, Coombes G, Newton-Bishop J, Timmons M, Cook M, Theaker J, Bliss JM, Thomas JM, UK Melanoma Study Group. Wide versus narrow excision margins for high-risk, primary cutaneous melanomas: long-term follow-up of survival in a randomized trial. The Lancet Oncology. 2016 Feb 1; 17(2):184-92.
https://doi.org/10.1016/S1470-2045(15)00482-9
May MM, Lohse CM, Moore EJ, Price DL, Van Abel KM, Brewer JD, Janus JR. Wide local excision prior to sentinel lymph node biopsy for primary melanoma of the head and neck. International Journal of Dermatology. 2019 Oct; 58(10):1184-90.
https://doi.org/10.1111/ijd.14435
Balch CM, Soong SJ, Smith T, Ross MI, Urist MM, Karakousis CP, Temple WJ, Mihm MC, Barnhill RL, Jewell WR, Wanebo HJ. Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1–4 mm melanomas. Annals of Surgical Oncology. 2001 Mar; 8(2):101-8.
https://doi.org/10.1245/aso.2001.8.2.101
Wheatley K, Wilson JS, Gaunt P, Marsden JR. Surgical excision margins in primary cutaneous melanoma: a meta-analysis and Bayesian probability evaluation. Cancer Treatment Reviews. 2016 Jan 1; 42:73-81.
https://doi.org/10.1016/j.ctrv.2015.10.013
Balch CM, Thompson JF, Gershenwald JE, Soong SJ, Ding S, McMasters KM, Coit DG, Eggermont AM, Gimotty PA, Johnson TM, Kirkwood JM. Age as a predictor of sentinel node metastasis among patients with localized melanoma: an inverse correlation of melanoma mortality and incidence of sentinel node metastasis among young and old patients. Annals of Surgical Oncology. 2014 Apr; 21(4):1075-81.
https://doi.org/10.1245/s10434-013-3464-x
Wright FC, Souter LH, Kellett S, Easson A, et al. Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline. Curr Oncol. 2019, 26(4):541-550.
https://doi.org/10.3747/co.26.4885
Patent 5664 UA, IPC A61B17/00. Method of transposition plasty the shin’s surgical wound. Galaychuk I.Y. – No. 20040706319; Announced on 07/29/04; Publ. 15.03.2005. Bul. No. 3.
Galaychuk IY, Babanly SR, Danylkiv IS, Shkrobot LV. Oncosurgical and dermatological approaches in diagnosis and treatment of patients with skin melanoma. Klinichna onkolohiia – Clinical Oncology. 3(15) (2014):41-44. [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 International Journal of Medicine and Medical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who sent their manuscript to International Journal of Medicine and Medical Research agree to the following terms:
1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC-BY-NC that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
2. Authors able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
