Advertisement

Annals of Surgical Oncology

, Volume 15, Issue 6, pp 1733–1740 | Cite as

Full-Thickness Grafts Procured from Skin Overlying the Sentinel Lymph Node Basin; Reconstruction of Primary Cutaneous Malignancy Excision Defects

  • James M. Lewis
  • Jonathan S. Zager
  • Daohai Yu
  • Diego Pelaez
  • Adam I. Riker
  • Sophie Dessureault
  • C. Wayne Cruse
  • Douglas S. Reintgen
  • Christopher A. Puleo
  • Vernon K. SondakEmail author
Melanomas

Abstract

Background

Radical excision of a cutaneous malignancy may require skin-graft closure. The skin overlying the sentinel lymph node (SLN) basin may be procured as a full-thickness skin graft (FTSG), eliminating a problematic and painful third wound, the donor site. However, the potential for implantation of malignant cells transferred from the nodal basin to the primary site, resulting in increased perigraft recurrence rates with the FTSG technique, has not been evaluated.

Methods

We retrospectively reviewed all patients with a cutaneous malignancy who underwent SLN biopsy and skin-graft closure to evaluate the outcomes of full-thickness sentinel node basin procured skin grafts compared with partial-thickness grafts (PTSG).

Results

Fifty-seven patients underwent FTSG reconstruction, and 39 patients had PTSG placed at the time of wide excision and SLN biopsy. Eighty-five percent of patients had melanoma; median melanoma thickness for FTSG patients (N = 53) was 2.0 vs. 2.8 mm (N = 29) for the PTSG group (P = .0007). Positive sentinel nodes were identified in nine of 57 patients (16%) and 11 of 39 patients (28%) in the FTSG and PTSG groups, respectively. Perigraft recurrence rates were not significantly different (5 vs. 10%) between the two groups. Graft take rate for the FTSG group was slightly higher than the PTSG group (median = 88% vs 80%, P = .008). FTSG cosmetic results were generally excellent.

Conclusions

This FTSG closure method eliminates a painful third wound and often results in a better cosmetic outcome. Perigraft recurrences do not appear to be increased with FTSG. This technique should be in the armamentarium of surgeons who treat cutaneous malignancy.

Key Words

Skin graft Melanoma Merkel cell carcinoma Sentinel lymph node biopsy 

Supplementary material

(WMV 4330 kb)

(WMV 5868 kb)

(WMV 5176 kb)

References

  1. 1.
    Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2008. CA Cancer J Clin 2008;58:71–96PubMedCrossRefGoogle Scholar
  2. 2.
    Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83PubMedGoogle Scholar
  3. 3.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9PubMedGoogle Scholar
  4. 4.
    Cochran AJ, Wen DR, Morton DL. Management of the regional lymph nodes in patients with cutaneous malignant melanoma. World J Surg. 1992;16:214–21PubMedCrossRefGoogle Scholar
  5. 5.
    Ross AS, Schmults CD. Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg. 2006;32:1309–21PubMedCrossRefGoogle Scholar
  6. 6.
    Ortin-Perez J, van Rijik MC, Valdes-Olmos RA, et al. Lymphatic mapping and sentinel node biopsy in Merkel’s cell carcinoma. Eur J Surg Oncol. 2007;33:119–22PubMedCrossRefGoogle Scholar
  7. 7.
    Dresel A, Kuhn JA, McCarty TM. Sentinel node biopsy site used as full thickness skin graft donor for cutaneous melanoma. Am J Surg. 2002;184:176–8PubMedCrossRefGoogle Scholar
  8. 8.
    Chennoufi M, Guihard T, Lantieri L. The skin overlying the sentinel lymph node: a full thickness skin graft donor site after local excision for cutaneous melanoma. Ann Chir Plast Esthet. 2007;52:35–8PubMedCrossRefGoogle Scholar
  9. 9.
    Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with the sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10:676–80PubMedCrossRefGoogle Scholar
  10. 10.
    Allen PJ, Bowne WB, Jaques DP, et al. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23:2300–9PubMedCrossRefGoogle Scholar
  11. 11.
    Medina-Franco H, Urist MM, Fiveash J, et al. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol. 2001;8:204–8PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • James M. Lewis
    • 1
    • 2
  • Jonathan S. Zager
    • 1
    • 2
  • Daohai Yu
    • 1
    • 3
  • Diego Pelaez
    • 4
  • Adam I. Riker
    • 5
  • Sophie Dessureault
    • 1
    • 6
  • C. Wayne Cruse
    • 2
  • Douglas S. Reintgen
    • 7
  • Christopher A. Puleo
    • 2
  • Vernon K. Sondak
    • 1
    • 2
    Email author
  1. 1.Department of Oncologic SciencesUniversity of South FloridaTampaUSA
  2. 2.Division of Cutaneous OncologyH. Lee Moffitt Cancer CenterTampaUSA
  3. 3.Division of BiostatisticsH. Lee Moffitt Cancer CenterTampaUSA
  4. 4.Division of Video ProductionH. Lee Moffitt Cancer CenterTampaUSA
  5. 5.Mitchell Cancer InstituteUniversity of South AlabamaMobileUSA
  6. 6.Division of Gastrointestinal OncologyH. Lee Moffitt Cancer CenterTampaUSA
  7. 7.Lakeland Regional Cancer CenterLakelandUSA

Personalised recommendations