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Immediate versus delayed reconstruction of head and neck cutaneous melanoma
Author(s) -
Quimby Alexandra E.,
Khalil Diana,
JohnsonObaseki Stephanie
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27250
Subject(s) - medicine , head and neck , surgery , melanoma , stage (stratigraphy) , odds ratio , paleontology , cancer research , biology
Objective Controversy exists regarding the surgical management of cutaneous melanoma and the optimal timing of reconstruction. One approach to ensuring an oncologically sound outcome is a two‐stage procedure, with reconstruction delayed for negative permanent section margins. Alternatively, a single‐stage excision with immediate reconstruction is advantageous because it limits both resource use and patient morbidity from multiple procedures. We sought to examine available published data on the oncologic outcomes associated with immediate versus delayed reconstruction of cutaneous melanoma in the head and neck region. Methods We performed a systematic review using EMBASE, Ovid MEDLINE, and PubMed. We examined all English‐language studies reporting oncologic outcomes (positive margins and/or local recurrence rates) of single‐stage or delayed reconstruction of cutaneous melanoma in the head and neck region. Our primary outcomes of interest were rates of positive margins requiring re‐excision and rates of local recurrence. A total of 1,557 studies were screened by three independent reviewers. Results Nine studies met inclusion criteria for final analysis. Two of the nine studies directly compared immediate versus delayed reconstruction and demonstrated lower rates of positive margins in the immediate reconstruction group (odds ratio 3.7, [95% CI 0. 79–17. 34]). Conclusion There are a paucity of studies directly comparing oncologic outcomes associated with immediate versus delayed reconstruction following excision of head and neck cutaneous melanoma. Based on a limited amount of heterogeneous data, single‐stage excision with immediate reconstruction may be an oncologically sound alternative to delayed reconstruction for head and neck cutaneous melanoma. Level of Evidence 3a. Laryngoscope , 2566–2572, 2018