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Characteristics and surgical treatment of recurrence melanoma of the foot: a case report and brief literature review.

OBJECTIVE
Despite advances in plastic and reconstructive surgery, repairing soft tissue defects of the foot remains a complex surgical challenge when conventional methods cannot cover defects. We presented a case in which a free flap was used for reconstruction and reviewed the literature.


PATIENTS AND METHODS
A 75-year-old woman with an acral melanoma history had a large exophytic mass on her right foot. Using PubMed, we found that reconstructive options in the literature include local flaps, fascial flaps, muscle flaps, and free flaps.


RESULTS
Melanoma recurred four times at the same site after complete excision of the compound nevi in the present case. Melan A, Vimentin (+), S-100 (+), and HMB-45 positivity were found in immunohistochemical staining and increased Ki-67 proliferation. The defects in soft tissue are repaired using a free anterolateral thigh perforator flap. No complications were raised in the patient.


CONCLUSIONS
Foot melanoma is difficult to be resected because it necessitates a wide excision, which can result in large defects. The free flap, in our experience, can easily be performed while preserving function and improving cosmesis. This flap is an appealing option for concealing defects in the distal extremities.