Reconstructive surgery in melanoma patients

The treatment of malignant melanoma should include a wide resection, the extent of which should be based on the tumor thickness of the primary site as well as the anatomic site of the location of the tumor. The various methods of reconstruction of these donor sites may include primary closure, split-thickness skin grafting, full-thickness skin grafting, or a number of local flaps. Each of these techniques is selected based on the size and extent of the wound necessitated by the wide excision. The concept that needs to be kept in mind is that the surgical treatment for a melanoma should be as wide as is indicated based on the depth of invasion, which is an indication for the potential of local recurrence. The areas should be treated most often with flaps to allow for early ambulation, decreased disability and cost of hospitalization, and improved functional and cosmetic results in the long term for the patient. It is my personal belief that with further experience in the use of these various flaps, surgeons will be able to provide secure wide surgical excisions of many sizes with greater confidence, because these areas can be resurfaced without disability. In this fashion, the extent of the surgical excision no longer should be a compromise for fear of difficulty in closing or resurfacing the wounds.