Отдаленные результаты пластических замещений дефектов после иссечения первичной меланомы кожи

Abstract

The results of surgical treatment of patients with primary skin melanoma (MC) were analyzed depending on the localization of the primary tumor, the type of incision and the method of suturing the postoperative defect. The necessity of performing a round excision of localized primary tumors of the trunk and elliptical excision on the extremities with subsequent plastic replacement in all cases was established. In stage III patients with any tumor localization, the type of incision and suturing of the defect was not of fundamental importance. It was revealed that patients with plasty of the postoperative defect with tumor localization on the trunk had an advantage over linear suturing in progression-free survival (PFS): with a rounded incision at all stages throughout the observation period (12, 36, 60 months) by 18.8, 23.8, 26.5% (p < 0.050). The greatest benefit in PFS was observed in patients with localized forms of melanoma from 0 to IIc st over the entire follow-up period 12, 36, 60 months: from 0–IIa st to 22.0, 31.8, 32.0%, with IIb–IIc st by 35.6, 28.5, 34.8%. With an elliptical incision in IIb–IIc st in the long term up to 36–60 months of observation by 25.7%. In the adjusted overall survival (AOS), patients with a rounded incision and plastic surgery in the initial stages of the disease 0-IIa up to 36 and 60 months had a benefit by 24.4 and 29.3%, respectively, and with an elliptical incision and plastic – from 0–IIa st in the period 12–36 months by 24.4%. With the localization of the primary tumor on the extremities, a statistical difference was revealed with the best indicators in patients with an elliptical incision and plastic surgery in PFS compared with patients with a rounded incision and plastic surgery in the period of 3–60 months by 18.6% and 26.7%, respectively, as well as over patients with a conventional incision without plastic surgery as a whole in the subgroup for periods up to 36 and 60 months by 26.4 and 29.4% with a tendency to improve this indicator in the long term, as well as better AOS in the long term in these patients with a difference by 19.3% (36–60 months of observation).