Malignant melanoma occurs most commonly on the cheek and thus is usually diagnosed early, and rarely needs large reconstructions for advanced disease. This is a retrospective study looking at 26 patients 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 the 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 for defects up to as large as 78cm2. The other considerations were exposed structures, such as bone, that cannot be grafted and tumour thickness and hence resultant defect. They suggest three factors are important in selecting a reconstruction procedure, size and aesthetic considerations. stage of the melanoma and age of the patient. The study is limited because of the patient numbers but it provides a good mental algorithm to use in assessment and planning of reconstruction. 

An analysis of cheek reconstruction after tumour excision in patients with melanoma.
Hayashi T, Furukawa H, Oyama A, et al.
2014;25: e98-101.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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