Immediate Reconstruction for Plantar Melanoma: A Paradigm Shift

Plantar melanoma tumors are traditionally treated with wide local excision based on depth of invasion, followed by delayed reconstruction once negative surgical margins are confirmed. However, delayed reconstruction requires care for an open wound, a prolonged treatment course, and the need for an additional surgery. Immediate reconstruction has been shown to be oncologically safe in head and neck melanoma, but little is described in the literature regarding immediate reconstruction in plantar melanoma. We present our experience with immediate reconstruction after wide local excision for lower extremity plantar melanomas.

We performed a retrospective review of all patients with biopsy-proven plantar melanoma who underwent wide local excision followed by immediate reconstruction of any type between 1999 and 2014 at the University of California, San Francisco. Patient demographics, postoperative complications, reoperation rates, and oncologic outcomes were collected.

Thirty-eight patients were identified, with a mean follow-up of 34 months. Skin grafts were the most common method of reconstruction, followed by primary closure, local flaps, and free flaps. Only 1 patient had a major complication, which was skin graft loss requiring reoperation. Eight patients had either local or distant recurrence (21%).

Immediate reconstruction for plantar melanomas can be safely performed with recurrence rates comparable and in line with previously published studies of wide local excision for plantar melanoma. This technique has the potential to achieve oncologically safe outcomes with less overall morbidity.