Prognosis of Malignant Melanoma on Lower Extremity.

Kim, Ji Ye; Lee, Won Jai; Lew, Dae Hyun; Rah, Dong Kyun; Tark, Kwan Chul

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(4):411-416.
Published online July 1, 2009.

Prognosis of Malignant Melanoma on Lower Extremity.

Ji Ye Kim, Won Jai Lee, Dae Hyun Lew, Dong Kyun Rah, Kwan Chul Tark

Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea. pswjlee@yuhs.ac

Abstract

PURPOSE
Malignant melanoma is recognized as the most serious skin cancer. We examined anatomical distribution and 5-year survival rate of each stage of malignant melanoma on lower leg. METHODS: We retrospectively analyzed the medical records of 91 patients(46 males and 45 females) with malignant melanoma on lower leg from 1985 to 2008. Age, sex, anatomical distribution and 5-year survival rates of each stage of malignant melanoma on lower leg were investigated. Also, 5-year survival rates of each stage and invasion depth of malignant melanoma on heel pad were investigated.
RESULTS
On lower leg, most frequently 32 cases (35.1%) occurred on heel pad, 27 cases(29.7%) occurred on dorsum of foot, 18 cases(19.8%) in toe, and 14 cases(15.4%) on others in lower leg. We used the excision margin as 3-5cm. After wide excision, in stage III, IV, the patients underwent the immunologic / chemo-therapy. The incidences of each stage were 22 cases(24.2%) in stage I, 47(51.6%) in II, 17(18.7%) in III and 5(5.5%) in IV. The 5-year survival rates of each stage were 85%, 53.2%, 47.1% and 40%. On heel pad, the incidences of each stage were 5 cases(15.6%) in stage I, 19 cases(59.4%) in II, 7 cases(21.9%) in III and 1 case(3.1%) in IV. The 5-year survival rates of each stage were 80%, 63.2%, 42.9% and 100%, respectively. On heel pad, incidence of local recurrence was 2 and 5-year survival rate of this case was 100%. And systemic recurrence was 9 and 5-year survival rate of this case was 55.6%.
CONCLUSION
The 5-year survival rate of malignant melanoma on heel pad was higher than previous study. To maintain the weight-bearing function of foot, we recommend the active reconstructive surgery for heel pad reconstruction after wide excision of heel pad malignant melanoma.

Keywords: Malignant melanoma; Lower leg; Heel pad reconstruction

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