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Influence of plastic surgery for melanoma on progression-free survival in patients with skin melanoma according to the degree of tumor lymphoid infiltration

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 1236 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.