Full-thickness grafts procured from skin overlying the sentinel lymph node basin; reconstruction of primary cutaneous malignancy excision defects

Abstract

Background: Radical excision of a cutaneous malignancy may require skin-graft closure. The skin overlying the sentinel lymph node (SLN) basin may be procured as a full-thickness skin graft (FTSG), eliminating a problematic and painful third wound, the donor site. However, the potential for implantation of malignant cells transferred from the nodal basin to the primary site, resulting in increased perigraft recurrence rates with the FTSG technique, has not been evaluated.

Methods: We retrospectively reviewed all patients with a cutaneous malignancy who underwent SLN biopsy and skin-graft closure to evaluate the outcomes of full-thickness sentinel node basin procured skin grafts compared with partial-thickness grafts (PTSG).

Results: Fifty-seven patients underwent FTSG reconstruction, and 39 patients had PTSG placed at the time of wide excision and SLN biopsy. Eighty-five percent of patients had melanoma; median melanoma thickness for FTSG patients (N = 53) was 2.0 vs. 2.8 mm (N = 29) for the PTSG group (P = .0007). Positive sentinel nodes were identified in nine of 57 patients (16%) and 11 of 39 patients (28%) in the FTSG and PTSG groups, respectively. Perigraft recurrence rates were not significantly different (5 vs. 10%) between the two groups. Graft take rate for the FTSG group was slightly higher than the PTSG group (median = 88% vs 80%, P = .008). FTSG cosmetic results were generally excellent.

Conclusions: This FTSG closure method eliminates a painful third wound and often results in a better cosmetic outcome. Perigraft recurrences do not appear to be increased with FTSG. This technique should be in the armamentarium of surgeons who treat cutaneous malignancy.