Melanomas of the head and neck have high–local recurrence risk features and require tissue-rearranging reconstruction more commonly than basal cell carcinoma and squamous cell carcinoma: A comparison of indications for microscopic margin control prior to reconstruction in 13,664 tumors

Fix, William C.; Etzkorn, Jeremy R.; Shin, Thuzar M.; Howe, Nicole; Bhatt, M.; Sobanko, Joseph F.; Miller, Christopher J.

doi:10.1016/j.jaad.2018.11.020

Cited by 12 publications

(13 citation statements)

References 77 publications

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“…LM of special sites such as the head and neck, genitalia, pretibial area, and hands and feet are 10 times more likely to require reconstruction with a flap or graft than melanomas on the trunk and proximal extremities. 29 , 30 , 31 The majority of tumors in our cohort needed tissue rearranging reconstruction, emphasizing the importance of complete margin assessment and certainty of melanoma clearance before undertaking a reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Lentigo Maligna of the head and neck: A retrospective study assessing surgical excision margins in a South African population

2022

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Section: Discussionmentioning

confidence: 99%

Lentigo Maligna of the head and neck: A retrospective study assessing surgical excision margins in a South African population

2022

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“…Moreover, in selected sensible areas, primary closure may produce long scars under tension, eventually leading to wound dehiscence, hypertrophic scarring and contour deformity (►Fig. 5).…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have shown their heterogeneous experience with flap reconstruction after melanoma resection, especially in the field of head and neck oncology. [5][6][7][8][9] Nevertheless, to date, reconstruction with flaps after melanoma resection is not considered as the first choice because of the theoretical possibility of altering the lymphatic drainage, therefore, making it hard to detect any relapses at an early time. However, evidence in literature about this subject is poor.…”

mentioning

confidence: 99%

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

Brunetti

Salzillo

Tenna

et al. 2021

J Reconstr Microsurg

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Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

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“…recurrence rates of CM due to particular risk features, such as, subclinical spread, larger preoperative size, more likely to have had previous treatment, and requiring tissuerearranging reconstruction when compared to keratinocytic tumors. 5 Immediate margin assessment provides the confidence of complete tumor removal. Unfortunately, hematoxylin and eosin frozen sections are notoriously difficult to interpret for CM, resulting in poor sensitivity and specificity.…”

Section: In-depth Review Melanoma Recurrence After Mohs Micrographic Surgery With Mart-1: a Systematic Review And Meta-analysismentioning

confidence: 99%

Melanoma Recurrence after Mohs Micrographic Surgery with MART-1: A Systematic Review and Meta-analysis

Long¹,

Dunn²,

Arndt³

et al. 2021

J of Skin

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Background: Surveys suggest wide-spread use of MART-1 in MMS for CM among Mohs surgeons, but no previous systematic review has investigated the efficacy of this specific procedure. Methods: A systematic search and meta-analysis of retrospective studies on MMS with MART-1 was performed from Pubmed, Medline, and Cochrane databases for articles published from their inception to October 30, 2020. We performed a chi-squared analysis of homogenized data to examine the relationship between recurrence location and rate of recurrence. A risk of bias was obtained with the ROBINS-I tool. [PROSPERO ID: CRD42020221826] Results: Among the included studies, there were a total of 15 (0.52%) local recurrences of melanoma in-situ and invasive melanoma after MMS with MART-1. Conclusions: This review has served to demonstrate that MMS with MART-1 immunostaining in frozen sections is a technique that produces satisfactory recurrence rates for melanoma in-situ and invasive melanoma.

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Melanomas of the head and neck have high–local recurrence risk features and require tissue-rearranging reconstruction more commonly than basal cell carcinoma and squamous cell carcinoma: A comparison of indications for microscopic margin control prior to reconstruction in 13,664 tumors

Cited by 12 publications

References 77 publications

Lentigo Maligna of the head and neck: A retrospective study assessing surgical excision margins in a South African population

Lentigo Maligna of the head and neck: A retrospective study assessing surgical excision margins in a South African population

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

Melanoma Recurrence after Mohs Micrographic Surgery with MART-1: A Systematic Review and Meta-analysis

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