Recurrence Rates Over 20 Years in the Treatment of Malignant Melanoma: Immediate Versus Delayed Reconstruction

Pieter G.L. Koolen, MD; Tiago R. Matos, MD; Ahmed M.S. Ibrahim, MD, PhD; Jie Sun, BA; Bernard T. Lee, MD, MBA, MPH; Robert A. Frankenthaler, MD; Samuel J. Lin, MD

doi:10.1097/GOX.0000000000001378

Plastic and Reconstructive Surgery, Global Open (Jul 2017)

Recurrence Rates Over 20 Years in the Treatment of Malignant Melanoma: Immediate Versus Delayed Reconstruction

Pieter G.L. Koolen, MD,
Tiago R. Matos, MD,
Ahmed M.S. Ibrahim, MD, PhD,
Jie Sun, BA,
Bernard T. Lee, MD, MBA, MPH,
Robert A. Frankenthaler, MD,
Samuel J. Lin, MD

Affiliations

Pieter G.L. Koolen, MD: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Tiago R. Matos, MD: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Ahmed M.S. Ibrahim, MD, PhD: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Jie Sun, BA: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Bernard T. Lee, MD, MBA, MPH: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Robert A. Frankenthaler, MD: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Samuel J. Lin, MD: From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; †Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.; ‡Harvard School of Dental Medicine, Boston, Mass.; and §Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

DOI: https://doi.org/10.1097/GOX.0000000000001378
Journal volume & issue: Vol. 5, no. 7

Abstract

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Background:. Wide local excision (WLE) with a safety margin is the standard of treatment for primary head and neck cutaneous malignant melanoma (HNCMM). Studies have demonstrated inconsistency in recurrence rates following immediate versus delayed reconstruction. The objectives of this study were to assess and compare recurrence rates after WLE of HNCMM followed by immediate or delayed reconstruction in determining recurrence-free survival estimates. Methods:. A consecutive, retrospective analysis of 451 patients undergoing WLE of primary HNCMM followed by reconstruction over a period of 20 years was performed. Patients were divided into 2 groups based on timing of reconstruction (immediate versus delayed). Univariate analyses were performed to assess distributions. Kaplan–Meier survival analysis and multivariate Cox proportional hazard analyses were performed to estimate recurrence-free survival. Results:. Tumor specimen positive margins were comparable between immediate and delayed reconstruction groups (P = 0.129). Univariate analysis demonstrated comparable local melanoma recurrence after immediate or delayed reconstruction (41.4% versus 53.3%; P = 0.399). After adjusting for prognostic factors, multivariate analysis also failed to demonstrate an association between reconstruction timing and local recurrence-free survival (P = 0.167). Conclusions:. In this long-term study, we were not able to demonstrate an association between reconstruction timing and local recurrence-free survival after excision WLE of HNCMM, rendering immediate reconstruction a reliable approach. In addition, the presence of ulceration and a positive sentinel lymph node were positively associated with the risk of recurrence.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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