ONCOPLASTIC CONE-SHAPED REMOVAL OF MELANOMA IN SITES WITH LIMITED SKIN RESOURCES

Background. According to the existing recommendations of the NCCN, 2-cm margins are optimal for surgical excision of skin melanoma (SM). Objective. A method of cone-shaped oncoplastic surgery of SM in sites with limited skin-plastic resources is presented. Methods. In the study 30 patients (11 men, 19 women) underwent cone-shaped removal of primary SM on arm and shin, epigastria and subclavicular sites. Oncosurgical approach involves the following: primary SM is excised with 2 cm margins around with transforming this round wound into conical using additional incisions; then conical wound is closed by transverse displacement of lateral skin-fatted flap. The postoperative seam looks like hook-shaped line. SM thickness is measured by sonography before surgery. Morphological verification is obtained by cytological examination of smears after superficial scraping biopsy. Results. Postoperative histology confirmed melanomas in all cases with “clear margins” in all surgical specimens, and postoperative staging was as follows: pT2bN0M0 – in 3 patients, pT2bN1-2M0 – 4 patients, pT3bN0M0 – 9 patients, pT4bN0M0 – 7 patients, and pT4bN1-2M0 – in 7 patients. Partial marginal necrosis of displaced flaps was of 4 patients (13.3%). There were no recurrences of melanoma at site of postoperative scar. 3-years disease free survival (DFS) rate was 76.6%, and 5 years DFS rate – 60.0%. Conclusions. Cone-shaped radical excision of primary melanoma is an appropriate surgery for patients with SM on the forearms, shoulders, epigastria and subclavicular sites and legs. The one-step oncoplastic radical surgery without intermediate biopsy prevents local recurrence in site of surgery as well as iatrogenic metastasis to regional lymph nodes.