Results of the surgical treatment of primary skin melanoma depending on the method of tumor excision and options for closing the surgical defect

The aim of the study was to analyze the results of the surgical treatment of patients with primary skin melanoma (SM) according to the location of the primary tumor, the type of incision, and the method of suturing the postoperative defect.

Material and methods. Patients with primary SM, treated in 2013 (n = 337) were studied; these patients were randomized into two groups using the method of blind selection to the main (n = 182) comparisons (n = 155) (after removal of the tumor, simple linear wound closure was performed).

Results. In patients with localized forms of SM, it was found necessary to perform a round incision when the tumor is localized on the trunk and an elliptical incision when localized on the extremities, followed by plastic replacement in all cases. In stage III patients with any tumor localization, the type of incision and suturing of the defect was not of fundamental importance.

Discussion. It was revealed that patients with tumor on the trunk after rounded incision and plastic surgery had an advantage in progression-free survival (PFS) at all stages before an elliptical incision without plastic surgery during the entire observation period (12–36–60 months) by 18.8%–23%, 8%–26.5% (p ˂ 0.050). Patients with localized forms of melanoma from stage 0 to IIc over the entire follow-up period of 12–36–60 months had the greatest benefit in PFS from a round incision with plastic before conventional suturing without plastic surgery: from stage 0 to IIa by 22.0%–31.8%–32.0%, from stage IIb to IIc by 35.6%–28.5%–34.8%. In overall survival (OS), only patients with a rounded incision and plastic surgery in the initial stages of the disease stage 0 to IIa up to 36 and 60 months benefited by 24.4% and 29.3%, respectively. Compared with patients who underwent simple excision on the trunk, patients with stage IIb–IIc with elliptical incisions and plasty had an advantage in PFS in the long term up to 36–60 months of follow-up by 25.7% and in IDS with stages 0-IIa in the period 12–36 months by 24.4%.

With the localization of the primary tumor on the extremities, a statistical difference was revealed with the best indicators in patients with an elliptical incision and plastic surgery in the OS compared to patients with a rounded incision and plastic surgery in the period of 36–60 months by 18.6% and 26.7%, respectively, as well as over patients with a conventional incision without plastic surgery in PFS as a whole in the subgroup at periods up to 36 and 60 months by 26.4% and 29.4% with a tendency to improve this indicator in the long term, as well as better SOS in the long term in these patients with a difference in OS of 19.3% (36–60 months of observation).

Conclusion. In patients with localized stages (0–IIc), with the localization of the primary SM on the trunk, it is necessary to perform a round excision followed by plasty of the defect with displaced tissues; in addition, it is advisable to have an elliptical incision along the axial line for the limbs, followed by plasty of the defect. In patients with stage III, the shape of the incision and the method of suturing do not play a significant role in PFS and OS.