Management of skin defect following resection of Stage IV scalp melanoma: A case report

Highlights • Large defects following giant scalp melanoma resection pose a challenge to surgeon. • Excision beyond galea difficult to close with skin grafts & flaps. • INTEGRA® following split-thickness-skin-graft may be used to cover the wound.
Introduction Surgical defect left following excision of a large and neglected scalp melanoma of can pose a significant challenge for the surgeon. Scalp reconstruction encompasses options such as skin flaps, grafts, and various mechanical techniques. In scalp excision that involves dissection beyond the galea, skin grafts and flaps may not take well and not enough tissue may be available for a skin flap. Presentation of case We present the case of a 64 year-old male with a giant scalp melanoma. The patient underwent excisional surgery of the tumor that left behind a large, galeal scalp wound defect. We used a dermal regeneration template (INTEGRA®) followed by negative pressure wound therapy (wound V.A.C.®), followed by split-thickness-skin-graft (STSG) to cover the wound. The patient was operated on and discharged home the same day and home health wound care was utilized for wound V.A.C.® maintenance. The patient underwent same day surgery for STSG two weeks later with great results. His one-month follow-up visit showed 100% graft take and a well-healing wound. Discussion The combination of INTEGRA®, negative pressure dressing, and skin graft proved to be a safe and effective solution to dealing with large wound defects following surgical excision of the tumor. This is likely secondary to neovascularization and regeneration of a dermal template that is achieved with the dermal regeneration matrix INTEGRA®. Other studies have shown that combination of negative pressure wound therapy with INTEGRA® promotes faster integration of the matrix and decreases wound complications such as infection. Conclusion The excellent results for this case present a very effective, time-expedient operative approach to surgical challenges in treating giant scalp melanomas. A four-week follow-up visit after INTEGRA® and wound V.A.C.® application indicated that Integra was well integrated to the calvarium with good neovascularization and granulation tissue evident. Skin grafting not only covered the defect completely, but also took to the scalp 100% with no wound breakdown or wound-healing issues.