Useful techniques for the resection of foot melanomas.

The prevalence of melanoma is rapidly increasing [1,2] and therefore more patients are being evaluated by surgeons for treatment of this tumor. A main component of the treatment of primary melanoma involves wide local excision (WLE) of the primary lesion or of the biopsy scar with adequate margins [1–8]. Although this may seem to be a simple task on certain areas of the body, such as the back, chest, abdomen, and proximal extremity, it can prove difficult to do on the foot while still maintaining adequate function and providing coverage. Since acral (distal extremity) melanomas account for 4% to 35% [2–5,7,8] of all cutaneous malignant melanomas depending on the population, we present useful techniques which provide excellent functional results in treating these difficult lesions. Because foot melanomas can be found on any surface of the foot, the foot should be thoroughly inspected as part of any skin examination. We have divided the foot into different anatomic regions as shown in Figure 1. Among the 2,439 cases of invasive melanomas compiled in a database established by the University of Michigan Multidisciplinary Melanoma Clinic, 63 (2.6%) were located on the foot (ankle lesions were excluded). The anatomic distribution and thickness of 57 of those cases are summarized in Table I (Breslow depth of the remaining 6 cases were unknown). As with other areas of the body, these lesions should undergo WLE with margins that are adequate for the histologic depth of the tumor. If the lesion is thin, and is located in a favorable location such as at the dorsum of the foot where there is some skin laxity, then a WLE and primary closure can be performed. However, acral lesions are generally thicker than lesions found elsewhere on the body [1,4]. Often, the alternate methods described below are required to obtain an optimal result. MATERIALS AND METHODS Toe Lesions