Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp

Abstract

Background: Scalp reconstruction in cases of melanoma excision can be challenging due to specific functional and aesthetic outcome requirements. Reconstructive techniques reported in the literature were reviewed to establish whether a surgical algorithm for the management of melanoma of the scalp may be deduced. Methods: A literature search was conducted to evaluate reconstructive strategies after melanoma wide local excision of the scalp according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were English language, diagnosis of melanoma of the scalp, and the presence of the following data: characteristics of the residual defect (width and depth), type of reconstruction, follow-up, and surgical outcome. Results: Six hundred twenty-five records were identified after excluding the duplicates; 48 full-text articles were assessed for eligibility, and 17 records were selected for inclusion. A total of 39 patients were included in the review. The majority of patients (n = 20) underwent skin grafting subsequent to dermal regeneration template positioning. Local flaps (n = 10), free flaps (n = 7), skin grafting alone (n = 1), and dermal regeneration template positioning alone (n = 1) were less frequent. Conclusions: Numerous reconstructive strategies for the scalp are described in the literature. Melanoma patients present a greater variability in terms of general health conditions and social needs that must be taken into account while choosing the most suitable procedure.

Technical refinements in the use of dermal regeneration template in full thickness scalp defects after radical cancer surgery

“…The treatment by DRT is recommended in the following cases: 1) elderly or extreme elderly patients which may present additional risk factor related to comorbidity [9,17,18] 2) in case of wide local excision (>4cm) [19][20][21] 3) in case of bone exposure resulting from the removal of the periosteum [8,9,22]; in this case it is recommended to drill the outer table to vascularize the DRT from the bone marrow [23] 4) in case of previous surgery with graft or flap failure or in case of recurrence of the neoplasm [9,24,25] 5) in case of previous radiation therapy (pre or postoperative irradiation at the surgical site) [26][27][28] 6) in patients with very aggressive cancer in which close postoperative clinical surveillance is deemed necessary. [17,21,24,27,29,30] There is also agreement among the authors that the use of the DRT is more economically advantageous than the cover with flaps [31] especially if the operated surface is greater than 120 square cm [23]. Some authors have proposed the use of the DRT with the one step technique without subsequent thin skin grafting, thus favoring healing by secondary intention [32].…”

Giant Soft Tissue Sarcoma of Scalp with Skull and Cerebral Invasion

“…Wide local excision is the treatment of choice but the difficulty in case of scalp tumors is the defect closure which requires tissue flaps. 7 Even after transfer, it is not cosmetically aesthetic due to the lack of hair over the transplanted portion. 7 In case of bony and cerebral invasion, these tumors can present with emergencies like intracerebral or extracerebral bleed.…”

“…7 Even after transfer, it is not cosmetically aesthetic due to the lack of hair over the transplanted portion. 7 In case of bony and cerebral invasion, these tumors can present with emergencies like intracerebral or extracerebral bleed. Limited invasion of the brain parenchyma can be treated with excision but large lesions are often unresectable and are associated with morbidity.…”

Modulation of A375 human melanoma cell proliferation and apoptosis by nitric oxide

“…Human melanoma is a fatal type of skin cancer and causes most skin cancer deaths. Only 20-30% of melanoma patients with visceral metastasis live beyond 5 years, and early detection with excision surgery is the sole reliable treatment of melanoma (Dind et al, 2021;Melo et al, 2021;Baldelli et al, 2020). Inflammation is important for maintaining homeostasis and monitoring stress signals that arise with tissue malfunction (Medzhitov, 2008).…”