Mohs Surgery and Reconstruction for Digit Melanoma: Analysis of Techniques and Post-Operative Limb Function
Jason D. Wink, MD, Irfan Rhemtulla, MD, William Fix, BA, Fabiola Enriquez, BA, Jaclyn Mauch, BA, John Barbieri, MD, Christopher J. Miller, MD, Benjamin Chang, MD, Ines Lin, MD, Stephen J. Kovach, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Digital melanoma of both the hand and foot is an insidious malignancy with a historically morbid management strategy. The goal of our study is to analyze reconstructive techniques and functional outcomes in patients undergoing digit sparing treatment.
An IRB-approved retrospective review(2011-2017) of patients undergoing surgery for a digit melanoma at the University of Pennsylvania was performed. Patients undergoing Mohs surgery+reconstruction or amputation were identified. Chart review identified location, defect-size, tumor-stage, reconstructive-technique and cancer-recurrence. Analysis was performed to understand the relationship between defect size and reconstruction of choice. Functional outcomes were assessed by administering either the Neuro-QOL Upper or Lower Extremity Function Surveys.
Thirty-two patients (13-Hand, 19-Foot, Age: 65.03 SD17.78yr) were identified, all with melanoma in-situ. No recurrence was identified with average follow-up of 16.1mos(1-95mos). Average defect size was 5.79 SD4.54 cm2. Reconstruction was performed 0-4 days after resection. Most common techniques included FTSG(N=7), Collagen Matrix+FTSG(N=4), Volar advancement flap(N=7) and technique choice appears correlated with defect size(p=0.0125). Neuro-QOL upper extremity survey results displayed a trend toward a significant difference between patients who underwent digit-sparing treatment(n=7) versus amputation (n=4)(T-Score: 42.5 SE5 vs. 31.2 SE3.1), p=0.11). No survey differences between digit-sparing treatment (n=8) and amputation(n=8) were identified in the lower extremity(T-Score: 51.1 SD4.9 vs. 56.2 SD 5.7, p=0.37).
Our results confirm digit-sparing treatment can confirm clear surgical margins and appears to improve upper extremity function compared to amputation, although this is not clearly seen in the lower extremity. Reconstructive technique is driven by the size of soft tissue deficit.
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