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

Abstract

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.

A Transient Metabolic State In Melanoma Persister Cells Mediated By Chemotherapeutic Treatments

“…13 For instance, a study performed over a period of 20 years (1994–2014) at the Beth Israel Deaconess Medical Center showed that patients with melanoma have an estimated 41.1% recurrence rate. 14…”

Dual-Agent Photodynamic Therapy with Optical Clearing Eradicates Pigmented Melanoma in Preclinical Tumor Models

“…Surgical resection is the standard first-line treatment for primary melanoma, often combined with chemotherapy, radiation therapy and, more recently, immunotherapy such as with the use of anti-PD1 monoclonal antibodies [ 2 , 3 ]. However, local recurrence rates remain high (≈40%) [ 4 ] and mortality rates have not improved significantly in the past 20 years.…”

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

“…The reported incidence of positive margins ranged from 6 to 20.9% (►Table 1). 4,[7][8][9][10][11][12][13][14] The average rate of positive margins on wide local excision specimens across all studies was 10.1% (170/1,690). Biopsy modality, multiple biopsies at tumor site prior to wide local excision, ulceration, tumor thickness, locally recurrent tumors, increasing patient age, melanoma in situ (MIS) component, noncompliance with recommended margins, histological regression, and the desmoplastic subtype were identified as risk factors for positive margins in these studies.…”

“…Multiple recent studies have made blanket conclusions that immediate reconstruction is "oncologically sound" and "safe" following excision with appropriate margins based on depth for cutaneous melanoma of the head and neck. [2][3][4] The only oncological reason to delay reconstruction is to await final pathological interpretation of the margin status of the definitive excision specimen so that reexcision of positive margins could be performed more precisely without compromising the reconstruction. Excision with appropriate margins based on depth and histological subtype, with or without sentinel lymph node biopsy, remains the most frequently recommended modality of treatment by the National Comprehensive Cancer Network.…”