The treatment of perianal skin horseshoe melanoma by advancement flap (Y-V shaped) and the assessment of outcome over a long-term follow-up

Abstract

A horseshoe perianal skin melanoma was treated by cutaneous advancement flap (Y-V shaped) and the outcome was investigated over a long-term follow-up. Objects of investigation were the history taking, the preoperative work-up, the adopted surgical procedure, and the histological and immune-histochemical findings concerning additional lesions found during the follow-up. The follow-up lasted 140 months. In this patient, a previous breast cancer was diagnosed and treated. Local diffusion of soft tissue, nodes, and anal sphincter infiltration or distant metastasis were not shown preoperatively. A wide excision with an advancement flap Y-V was carried out. Histological findings showed a level II of Clark with Breslow 0.65 mm. No local or distant recurrences were found by follow-up. Sixty months later, two pigmented lesions (0.3 0.2 mm) were detected and removed. Histologically, a hyperpigmentation of the basal layer of epidermis and immunostaining with Melan-A and CD 117 confirmed the absence of any significant melanocytic proliferation. Ninety months after the first procedure, a new small cell carcinoma of the right lung was detected leading the patient to death after 140 months. The findings of this report raise issues related to plastic and reconstructive modality but also to oncological outcome. We were also able to recognize a possible compromised immune deficiency over a considerable life span. However, the occurrence of melanoma did not affect the unfavorable outcome, which was caused by other cancers. Level of Evidence: Level V, prognostic study