The examination of 623 melanoma patients in North Germany yielded the depigmentation disorder vitiligo in 23 cases (i.e. 3.7%). In 11 patients, the disease preceded their tumor, whereas in 11 patients, vitiligo developed after diagnosis of primary and/or metastatic melanoma into the regional lymph nodes. In 1 case the onset of melanoma in relation to the tumor remained undefined. The prevalence of vitiligo increased with tumor risk factors based on tumor thickness and anatomical site of tumor location (i.e. for low risk 1.75% intermediate risk 5.2% and high risk 5.8%). A comparison of the prevalence of vitiligo to the normal population of Northwestern Europe (i. e. 0.38–0.57%) showed a 7- to 10-fold increase for the patients with melanoma. A reverse analysis of the data yielded a 180-fold higher prevalence of melanoma in the group of patients with vitiligo. These results strongly support a more thorough examination of patients with vitiligo for primary melanoma.

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Objective To examine the early and late flap related morbidity and associated risk factors in patients with modified vertical rectus abdominis myocutaneous (VRAM) flap neovaginal reconstruction at the time of pelvic exenteration for gynecologic malignancy. Methods From January 1993 to January 2011, all patients were identified who underwent anterior, posterior, or total pelvic exenteration with VRAM flap neovaginal reconstruction. Patient records were systematically reviewed and demographic, clinicopathologic, operative details, flap related complications, and risk factors for wound healing were recorded and statistical analysis performed. Results 46 patients were identified who underwent exenteration with VRAM flap vaginal reconstruction. A risk factor for poor healing including obesity, diabetes, smoking, prior radiation, previous abdominal surgery, or poor nutritional status was present in 38 (82.6%) patients, and 24 (52.2%) had two or more risk factors. Flap complications occurred in 9 (19.6%) patients, one with complete flap necrosis that required re-operation, two with superficial flap necrosis, and three with superficial flap separation. Three patients (6.5%) suffered from vaginal stenosis, one of which was complete. Anterior abdominal wound separation occurred in 22 (47.8%) patients and pelvic abscess occurred in 14 (30.4%) patients. No individual risk factor was significantly associated with VRAM flap related morbidity; however obesity, prior radiation, and prior abdominal incision were present in nearly all the patients with flap complications. Conclusions This series confirms that modified VRAM flaps can be used successfully at the time of exenteration, even in an increasingly high risk patient population with an acceptable risk for flap complications.

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