Recurrence Rates Over 20 Years in the Treatment of Malignant Melanoma: Immediate Versus Delayed Reconstruction

Background: Wide local excision (WLE) with a safety margin is the standard of treatment for primary head and neck cutaneous malignant melanoma (HNCMM). Studies have demonstrated inconsistency in recurrence rates following immediate versus delayed reconstruction. The objectives of this study were to assess and compare recurrence rates after WLE of HNCMM followed by immediate or delayed reconstruction in determining recurrence-free survival estimates. Methods: A consecutive, retrospective analysis of 451 patients undergoing WLE of primary HNCMM followed by reconstruction over a period of 20 years was performed. Patients were divided into 2 groups based on timing of reconstruction (immediate versus delayed). Univariate analyses were performed to assess distributions. Kaplan–Meier survival analysis and multivariate Cox proportional hazard analyses were performed to estimate recurrence-free survival. Results: Tumor specimen positive margins were comparable between immediate and delayed reconstruction groups (P = 0.129). Univariate analysis demonstrated comparable local melanoma recurrence after immediate or delayed reconstruction (41.4% versus 53.3%; P = 0.399). After adjusting for prognostic factors, multivariate analysis also failed to demonstrate an association between reconstruction timing and local recurrence-free survival (P = 0.167). Conclusions: In this long-term study, we were not able to demonstrate an association between reconstruction timing and local recurrence-free survival after excision WLE of HNCMM, rendering immediate reconstruction a reliable approach. In addition, the presence of ulceration and a positive sentinel lymph node were positively associated with the risk of recurrence.

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