Lentigo maligna melanoma and lentigo maligna are typically located on photo-exposed sites such as the head and neck, with the cheek being the most common site. Since lentigo maligna melanoma and lentigo maligna are found predominantly on such cosmetically-sensitive areas, it is critical to determine the exact histologic margin for maximal sparing of tissue and complete extirpation of the tumor. Since Mohs micrographic surgery has been recommended for tumors on cosmetically-sensitive locations where the tumor margin is indistinct, it appears to be a reasonable treatment modality for this type of tumor. We describe a case of lentigo maligna melanoma on the cheek, which was resected with Mohs micrographic surgery.
Cheek ; Head ; Hutchinson's Melanotic Freckle* ; Lentigo* ; Melanoma* ; Mohs Surgery* ; Neck

Objective: To analyze the clinical features and prognosis of patients with cutaneous melanoma. Methods: The clinical data and follow-up data of 125 patients with cutaneous malignant melanoma (CMM) treated in the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between February 2008 and August 2019 were collected. Kaplan-Meier method and Log rank test were used for survival analysis, and Cox proportional risk regression model was used for impact factor analysis. Results: Among the 125 patients, 12 were stage Ⅰ, 62 were stage Ⅱ, 30 were stage Ⅲ, and 21 were stage Ⅳ; 76 were acral and 49 were non-acral. The median survival time was 44 months, and the 1-, 2-, and 5-year survival rates were 85.4%, 63.2% and 38.7%, respectively. Kaplan-Meier univariate survival analysis showed that Karnofsky performance status score, tumor stage, primary site, vascular infiltration, Ki-67, BRAF, lactate dehydrogenase (LDH), and surgical treatment were related to the prognosis of patients (P<0.05). The median overall survival (OS) time of patients receiving interferon treatment was 53 months, which was better than 40 months of patients not receiving interferon treatment, but the difference was not statistically significant (P=0.448). Among stage Ⅲ patients, the median OS time of patients receiving interferon therapy was 40 months, which was better than 17 months of patients not receiving interferon therapy (P=0.012). Among stage Ⅱ patients, the 1-, 2-, and 5-year survival rates of acral patients were 97.1%, 84.7%, and 65.8%, and the 1-, 2-, and 5-year survival rates of non-acral patients were 93.3%, 70.0% and 17.0%. The prognosis of patients with stage Ⅱ acral type was better than that of non-acral type (P=0.043). The median survival time of stage Ⅲ patients with acral type was 32 months, better than 17 months of non-acral type, but the difference was not statistical significance (P=0.164). The median survival time of acral type and non-acral type was 8 months and 11 months respectively (P=0.458). Cox multivariate analysis showed that tumor stage and preoperative LDH level were independent prognostic risk factors for cutaneous melanoma. Conclusions: Interferon treatment can improve the prognosis of patients with stage Ⅲ, and stage Ⅱ acral type patients have better prognosis than that of non-acral type patients. Tumor stage and preoperative LDH level were independent prognostic risk factors for cutaneous melanoma.
Humans ; Melanoma/surgery* ; Skin Neoplasms/pathology* ; Prognosis ; Interferons ; Retrospective Studies

Primary malignant melanoma of the esophagus (PMME) is an extremely rare tumor with only scattered cases reported. Although surgical resection has been considered as the best possible option, the prognosis has been nonetheless poor. We report a case of PMME which was treated by surgical resection and additionally followed by chemotherapy. A 60-yr-old man underwent an esophagoscopy due to a 3-month history of dysphagia and upper abdominal discomfort. A pigmented polypoid mass in the lower third of the esophagus was discovered, and a biopsy identified the mass as a malignant melanoma. Consequently, a subtotal esophagectomy and intrathoracic esophagogastrostomy was carried out. At follow-up four months after discharge, lymph node enlargements in the cervical area and celiac axis area were found. As a result, the patients was started on systemic chemotherapy treatment, which included Dacarbazine. The patient has been doing well and is now 35 months post-operative.
Middle Aged ; Melanoma/pathology/*surgery ; Male ; Humans ; Esophageal Neoplasms/pathology/*surgery

Follow-Up Studies ; Forearm ; Humans ; Infant, Newborn ; Male ; Melanoma ; congenital ; surgery ; Skin Neoplasms ; congenital ; surgery

Female ; Humans ; Melanoma/surgery* ; Neoplasms, Multiple Primary/pathology* ; Ovarian Neoplasms/pathology* ; Skin Neoplasms ; Teratoma/surgery*

Acute Disease ; Adult ; Choroid Neoplasms ; surgery ; Female ; Humans ; Male ; Melanoma ; surgery ; Middle Aged ; Pulmonary Embolism ; etiology ; Uveal Neoplasms ; surgery

OBJECTIVETo introduce the application of slender narrow pedicle flap in repairing facial tissue defects after skin carcinoma excision, and investigate its survival mechanism.

METHODSThe slender narrow pedicle iateral maxillocevical flap was designed with its pedicle including skin fascia or only the fascia located in front of auricle or behind of it, repaired 26 cases of facial defects, including 5 temporal skin basal cell carcinoma, 6 skin squamous cell carcinoma, and 1 facial skin malignant melanoma, 8 skin basal cell carcinoma, 5 skin squamous cell carcinoma, 1 skin mucinous carcinoma. In 26 cases, 24 cases their pedicles in front of the auricle, 2 cases behind of the auricle; 4 cases their pedicles only including fascia. The size of the flaps ranged from 3.0 cm x 2.5 cm to 10.0 cm x 8.0 cm. The width and length of the pedicle ranged 1.0-1.5 cm and 2-6 cm.

RESULTS26 cases of the slender narrow pedicle flaps all survived and the results were satisfactory except 5 cases of distal congestion, then gradual recovery.

CONCLUSIONSThis slender narrow flap don't include any major blood vessel, without dissecting the blood vessels in operating. Due to its slender pedicle, the whole flap looks like "pingpang bat", the flap rotation is easy and its coverage area is very large, without cat ears. The postoperative appearance (color, texture, cosmetic aspect) is satisfactory. This slender narrow flap is an extraordinary new flap design and is ideal for the repair of the facial tissue defect after skin carcinoma excision.

Carcinoma, Basal Cell ; surgery ; Carcinoma, Squamous Cell ; surgery ; Ear Auricle ; Ear, External ; Facial Neoplasms ; surgery ; Fascia ; transplantation ; Humans ; Melanoma ; surgery ; Skin Neoplasms ; surgery ; Surgical Flaps ; transplantation

Skin neoplasms can result in large skin defects after surgical removal. Skin grafting has been used commonly to repair large defects, but it is associated with esthetic and functional problems. Herein, we report three cases with application of the keystone island flap in large skin defects of the trunk and extremities. A 53-year old male with recurred dermatofibrosarcoma protuberans on his thigh was repaired by the keystone island flap after Mohs micrographic surgery, and a 52-year old male with malignant melanoma on his back was successfully reconstructed by the keystone island flap after wide excision. Lastly, a 59-year old male diagnosed with dermatofibrosarcoma protuberans on the inguinal area was closed by the keystone island flap with commendable cosmetic outcome. Due to the ease of performance, excellent cosmetic and functional results, we recommend the keystone island flap for the reconstruction of large skin defects on the trunk and extremities.
Dermatofibrosarcoma ; Extremities ; Humans ; Male ; Melanoma ; Mohs Surgery ; Skin Neoplasms ; Skin Transplantation ; Skin* ; Thigh

Lentigo maligna melanoma (LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM located on the left lower eyelid of an 86-year-old woman. This female patient presented with a longstanding irregular brownish patch containing black macules consistent with LMM. There are several treatment modalities for removing the LMM lesion. However, considering the functional and the aesthetic aspect of the lower eyelid, we performed Mohs micrographic surgery to remove the lesion, and lateral based transposition flap was employed to reconstruct the resultant defect on the left lower eyelid.
Aged ; Aged, 80 and over ; Eyelids ; Female ; Humans ; Hutchinson's Melanotic Freckle* ; Lentigo* ; Melanoma* ; Mohs Surgery* ; Skin

OBJECTIVETo investigate the possibility and efficacy of allograft transplantation in treating patient with huge tissue defect after radical giant malignant melanoma resection.

METHODSA male person received blood type matching was chosen as donor. Immediately after the donor's brain death, allograft was excised with the depth to the layer intervenient between periosteum and epicranial fascia in calvaria, the superficial layer of deep temporal fascia in both sides of temporal regions, close to zygomatic bones and mandibles including masseter and auricles upon in face, and cervical soft tissues including sternocleidomastoid muscles, cervical and external jugular vessels of both sides were excised simultaneously. After being perfused with 4 degrees C UW solution through both common carotid arteries, the homograft was sheared and radiated with X-ray before being preserved in UW solution for further use. During the operation, both sides of external auditory meatus were anastomosed with ears firstly, and vessels were anastomosed end-to-end sequently, at last, the border of skin flap was sutured intermittently. Combined use of MMF, FK506, Prednisone and Zenopax was performed as post-operation immunosuppressive treatment. Clinical observations were made on the signs and symptoms of graft survival or rejection as well as blood FK506 concentrations and immunological indexes were tested in laboratory. Biopsies of graft were also made at 1 h, 4 h, 8 h, 7 d, 14 d and 30 d after operation.

RESULTSThe circulation of the graft was satisfactory, and the temperature and color of skin were normal. Primary healing of suture and hair growth about 0.8 cm in a month were observed. Skin Biopsies of every time had no found of hyperacute or acute rejection. The concentration of FK506 was maintained 20 mg/ml 1 month after the operation.

CONCLUSIONAllograft transplantation with compound tissue of head skin flap and ears is a kind of effective and safe treatment in repairing huge tissue defect. Good tissue matching and combined use of currently available immunosuppressants can prevent hyperacute and acute rejection efficiently.

Aged ; Ear ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Melanoma ; surgery ; Neck ; Surgical Flaps ; Transplantation, Homologous