[Resection of malignant melanoma on heel and reconstruction of defect]

To study the surgical resection and reconstruction methods of malignant melanoma on the heel.

Between July 2007 and June 2009, 15 cases of malignant melanoma on the heel were treated. There were 9 males and 6 females, aged from 32 to 71 years with a mean age of 47.2 years. Of them, 13 patients were initially treated, and 2 patients received repair after local excision. Tumor thickness was from 0.6 mm to 7.2 mm, and the size of the lesion was from 1.3 cm x 0.5 cm to 5.0 cm x 3.5 cm. According to the American Joint Committee on Cancer (AJCC) stage system, there were 1 case of IA, 2 cases of IB, 3 cases of IIA, 5 cases of IIB, 1 case of IIC, and 3 cases of III. Wide excision was performed in all cases. Defects were repaired by medial pedal skin flap (5 cases), lateral pedal skin flap (2 cases), and retrograde skin flap supplied by sural nutrition blood vessels (8 cases), and the flap size ranged from 7 cm x 5 cm to 12 cm x 8 cm. Inguinal lymph node dissection was performed in 3 patients. Wounds of donor site were repaired by skin graft.

One case had marginal necrosis of lateral pedal skin flap and 2 cases had local necrosis of medial pedal skin flap on the skin graft; the other flaps and skin grafts survived and incisions healed by first intention. All patients were followed up from 12 to 36 months (mean, 21 months). Considering the recovery of the function and sense, the best result was acquired in the lateral pedal skin flap, followed by the medial pedal skin flap, and the poor result in the retrograde skin flap supplied by sural nutrition blood vessel. No patient had local recurrence at follow-up. Five patients had inguinal lymph node metastasis, and 1 patient died of lung metastasis.

Wide resection can provide satisfactory local control for malignant melanoma on the heel. Local flap can cover the wound safely, but the retrograde skin flap supplied by sural nutrition blood vessel has poor sensory recovery.