The Role of Full-Thickness Scalp Resection for Management of Primary Scalp Melanoma

Abstract

BACKGROUND Scalp melanoma is aggressive and has a proclivity for regional metastasis. We hypothesize that subperiosteal scalp melanoma resection reduces in-transit/satellite recurrence, when compared to subgaleal resection. METHODS We identified patients with intermediate to deep, primary scalp melanoma referred to head/neck surgery over an eight-year period. Patients were compared based on scalp resection depth, including subperiosteal (resection to the level of calvarium) and subgaleal (resection including skin, subcutaneous tissue, and galea). The dependent variables were in-transit/satellite recurrence and time to in-transit/satellite recurrence. RESULTS Among 48 identified patients, the in-transit/satellite recurrence rate was 16.7%. Subgaleal resection patients had higher in-transit/satellite recurrence rates than subperiosteal resection patients (24.0% vs. 8.7%, p=0.155). Among node-negative patients, subgaleal resection had significantly higher in-transit/satellite metastasis rates when compared to subperiosteal resection (26.3% vs. 0%, p=0.047). CONCLUSION For node-negative, primary scalp melanoma, subperiosteal resection significantly decreases in-transit/satellite recurrence when compared to subgaleal resection. Given our small sample size, further studies are necessary to confirm these results.

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

“…10,12,14,15,17–20,22–24,27,28,30–34,36–38,40 Percent take was >90% in studies not employing bone burring. 9,11,12,16,17,29,35,39,41 …”

Primary cutaneous melanoma of the scalp: Patterns of recurrence

“…This method of excision also conveniently permits direct skin grafting to the periosteum and aside from several patients reported in this cohort, a sub‐galeal resection is our routine practice. The role of a deeper resection plane in the scalp has been raised as a potential reason for worse loco‐regional control after a WLE for scalp melanoma . The study by Pannucci et al, although limited in sample size ( n = 36), found a significantly worse rate of local metastases on univariate analysis for a sub‐galeal resection plane as compared with the sub‐periosteal plane for patients with primary scalp melanoma (26.3% vs. 0%; P = 0.047).…”

“…Most published series and registries integrate the outcomes of scalp melanoma with other anatomical sites, particularly the neck . To date, there are three analyses focusing on the patterns of recurrence for primary cutaneous scalp melanoma in the literature . Recent work by Pannucci and co‐workers suggested a potential advantage in local scalp control by performing a sub‐periosteal resection of the primary lesion.…”

“…3,7 To date, there are three analyses focusing on the patterns of recurrence for primary cutaneous scalp melanoma in the literature. [8][9][10] Recent work by Pannucci and co-workers 10 suggested a potential advantage in local scalp control by performing a sub-periosteal resection of the primary lesion. There have been no other studies in the literature related to depth of resection, anatomical planes of resection, surgical margin, or the role of reconstructive methods to obtain optimal results for primary scalp melanoma.…”

47 Diagnosis and Treatment of Cutaneous Malignancies

“…One series demonstrated subperiosteal resection to decrease in-transit recurrence in node-negative primary scalp melanomas compared to subgaleal resection. 126 Melanomas overlying the parotid gland should be excised down to the parotid fascia; parotidectomy is indicated if melanoma involves the superficial parotid fascia.…”