Vol 25, No 4 (2020)

The aim of the study was to analyze the effect of plastic methods for closing the defect after excision of primary skin melanoma according to the degree of lymphoid infiltration of the tumor.

Material and methods. Patients with primary skin melanoma (SM) treated in 2013 (n = 337) were studied; these patients were randomized into 2 groups using the method of blind selection to the main (n = 182). In these groups, the tumor removal operation in patients ended with plastic tissue defect and the group comparisons (n = 155) (after removal of the tumor, simple linear wound closure was performed).

Results. It was found that pronounced lymphoid tumor infiltration in patients with primary skin melanoma as a predictor of a favorable prognosis (in terms of the occurrence of locoregional recurrence) is realized in patients with plastic defect replacement significantly 2 times more often than in patients without plastic surgery in the period from 12 to 60 months of observation.

Discussion. The dependence of the occurrence of locoregional relapses in patients on lymphoid infiltration of the tumor and the performance of plastic surgery was revealed. In general, all patients who underwent plastic surgery have an advantage in terms of the occurrence of locoregional relapses in the long term for a period of up to 5 years by 12.5%. In patients with severe lymphoid infiltration and plastic surgery, locoregional relapses occur almost 2 times less often than in patients without plastic surgery, starting from a follow-up period of 12–36 months by 20.6% (22.9% and 43.5%, respectively; p = 0.008), and in the period from 36 to 60 months of observation by 24.7% (25.3% and 50.0%, respectively; p = 0.002).

Conclusion. The use of plastic techniques for closing a wound defect in patients with skin melanoma with pronounced lymphoid tumor infiltration reduces the risk of gross scarring and halves the risk of locoregional metastasis as compared to linear suturing of the postoperative 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.

In the structure of gynecological oncological pathology, vulvar cancer is located after cancer of the body of the uterus, cervix, and ovaries. The first publications on the surgical treatment of vulvar cancer date back to the second half of the 19th century. In the works of surgeons F. J. Taussig (1949) and S. Way (1960), radical vulvectomy with regional lymphadenectomy became a method of treating patients with invasive squamous cell carcinoma of the vulva. With this aggressive approach, sufficiently high levels of five-year survival of patients with vulvar cancer were achieved — up to 90% in a localized process, and up to 50% in the presence of metastases in regional lymph nodes. In the 1980s and 1990s, the transition from ultra-radical operations to economical, sparing ones became possible because of factors such as the introduction of the sentinel lymph node determination method. Ramon M. Cabanas in the 1960s first coined the term sentinel of signal lymph node. Surgical treatment for vulvar cancer has evolved over time, from extended, ultra-radical surgeries to a more individualized, conservative surgical approach, including widespread local excision with sentinel lymph node (SLN) detection instead of extended surgeries for early vulvar cancer. The evolution of the surgical treatment of vulvar cancer over the years is undoubtedly associated with the developments of the surgical technique, understanding of the biology of tumor growth, and radiation medicine along with the possibilities of drug therapy. The transition from simple tumor excision to extended, ultra-radical operations with inguinal-femoral, retroperitoneal, and pelvic lymphadenectomy made it possible to achieve good survival rates for this group of patients. In any case, further research is required to understand the adequate scope of surgical treatment for vulvar cancer.