Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 7-8, Pages: 436-439
https://doi.org/10.2298/SARH1608436V
Full text ( 2495 KB)
Primary reconstruction of neck defect after excision of metastatic melanoma of unknown primary site with regional pectoral myocutaneous flap
Veličkov Asen (Clinikum Coburg, Clinic for Traumatology and Orthopedics, Coburg, Germany)
Kovačević Predrag (Clinical Center Niš, Clinic for Plastic and Reconstructive Surgery, Niš + Medical Faculty, Niš)
Veličkov Aleksandra (Medical Faculty, Niš)
Ghanaati Shahram (Goethe University, Clinic for Maxillofacial Surgery, Frankfurt am Main, Germany)
Introduction. Metastatic melanoma of unknown primary (MMUP) is already a well
described oncologic phenomenon in the literature, whereas tissue defects’
reconstructions on the neck region always present a challenge for the
reconstructive surgeon. Two cases of giant metastatic, skin infiltrative neck
tumor masses are presented. In both cases MMUP was diagnosed. Both
intraoperative tissue defects were reconstructed using pectoralis major (PM)
regional flap. Outline of cases. The first patient was admitted with giant
tumor mass on the right side of the neck. The fast growing mass appeared two
months prior to the admission. Thorough examination showed no signs of
primary tumor. Removal surgery was performed and the defect was reconstructed
using the PM musculocutaneous flap. The second patient was admitted with
large tumor mass on the left side of the neck. Thorough examination displayed
no signs of any primary tumor. After the excision, the tumor mass and
subsequent neck dissection, reconstruction followed, using the pedicled PM
muscle flap and partial thickness skin transplants. There were no major
complications in either case. The histopathological examinations presented
metastatic melanoma diagnoses. Conclusion. Clinical outcome of MMUP described
in literature is rather variable. Different studies have shown that prognosis
in patients with MMUP is better than that in patients with diagnosed primary
melanoma with metastatic disease. Therefore, the best initial course of
action in those cases would be surgery, according to oncological principles,
if possible. Neck defects’ reconstructions should fulfill both functional and
esthetic demands. Due to the reliability and low cost of the procedure, PM
regional flap presents a very good and trustworthy reconstruction modality.
Keywords: metastatic melanoma of unknown primary, pectoralis major flap, surgery, reconstruction, neck tumor