(CS-068) Desmoplastic Melanoma: Complete Closure of Large Scalp Vertex Excision Without Reoperation

Caroline Hardy, DNP, APRN, FNP-C – Assistant Professor, Christine E. Lynn College of Nursing, Florida Atlantic University

Introduction: Melanomas of the head and neck can be particularly challenging to treat and definitively close considering the anatomic challenges and frequent need for adjuvant chemoradiation therapy. Large volume tissue loss and adjuvant therapies can cause significant morbidity and oftentimes require numerous surgeries including split thickness skin grafting and myocutaneous flap reconstruction. Desmoplastic melanoma (DM) is a rare subtype of melanoma characterized by scar-like growths with spindle-shaped cells making up approximately 4% of cutaneous melanoma cases. i Due to their atypical appearance, there is often a delay in diagnosis, further adding to the complex task of skin closure. ⁱⁱ



Methods: Numerous advanced wound care modalities and techniques were utilized to treat an approximately 70 cm2 surgical excision in the setting of concurrent radiation therapy as well as chronic immunosuppression for a history of bilateral lung transplant. This included the use of serial sharp debridement, non-contact low frequency ultrasound, bi-layered neonatal foreskin, various collagen scaffolding products, and a variety of advanced wound dressing.

Results: The authors highlight a case of widely excised scalp vertex melanoma successfully closed without reoperation.

Discussion: While the use of many advanced wound care products and techniques proved successful, equally important was the inter-departmental collaboration between our dermatology, ENT, oncology, radiation oncology, and primary care colleagues. Close communication, frequent follow-up, and flexible clinic scheduling allowed for timely wound care treatments and procedures while also undergoing daily radiation therapy resulting in complete wound closure and no further evidence of disease.