Malignant melanoma occurs most commonly on the cheek and thus are usually diagnosed early, rarely needing large reconstructions following advanced disease. This is a retrospective looking at 26 patients identified that had undergone treatment for cheek melanomas between 1996 and February 2012. Reconstruction was with skin grafts (split in nine and full in three cases), seven with local flaps and seven with free flaps. The authors quantify the size of the defects and methods of reconstruction. On average skin defect was 41.4cm2 with skin grafts, 24.9cm2 with local flaps and 76.7cm2 with free flaps. The authors discuss the range of the size of the defects and suggest the dividing line between local or free flaps as 40cm2. Skin grafts meanwhile, being so much more versatile can be used up to defects as large as 78cm2. The other considerations were exposed structures such as bone that cannot be grafted and thickness of the tumour and hence resultant defect. The authors have done what they set out to do, namely to discuss their reconstructions following excision of cheek melanomas. They suggest three factors are important in deciding on a reconstruction procedure, size (and aesthetic considerations), severity of the melanoma and age of the patient. The study is limited because of the patient size but it is a good mental algorithm to use in assessing patients and planning reconstruction.

An analysis of cheek reconstruction after tumor excision in patients with melanoma.
Hayashi T, Furukawa H, Oyama A, et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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