Patterns of reconstruction following margin-controlled surgery for melanoma of the lentigo maligna type of the head and neck

Abstract

Melanoma of the lentigo maligna (LM) type is most commonly located on the head and neck region. This subtype of melanoma poses surgical challenges due to its location on anatomically sensitive areas and frequent presence of subclinical extension. To analyze the reconstruction patterns of LM patients undergoing margin-controlled surgery. An observational study was conducted at Memorial Sloan Kettering Cancer Center, enrolling patients who underwent staged excision for the LM between November 2006 and April 2019. The study included 519 patients. Following margin-controlled surgery, the size of the surgical defects varied: <10 mm(36.2%), 10 and 30 mm (36.8%), and > 30 mm (27%). A flap reconstruction was the most common reconstructive technique (42.6%), followed by primary closure (32.6%), and graft (21.8%). Age was significantly associated with reconstruction type, with older patients more likely to undergo graft reconstructions (p = 0.014). Larger defects (> 30 mm) were reconstructed with grafts and flaps more often compared to smaller defects (p < 0.001 and p = 0.02, respectively). Understanding the scope of reconstruction is important for effective pre-surgical counseling and treatment planning. These findings highlight the importance of personalized strategies considering patients' age and defect size.

Keywords: Flap; Graft; Head and neck; Lentigo maligna; Melanoma; Reconstruction; Surgery.