title: Melanoma Extirpation with Immediate Reconstruction: The Oncologic Safety and Cost Savings of Single-Stage Treatment.
abstract: BACKGROUND
  The timing of reconstruction following melanoma extirpation remains controversial, with some advocating definitive reconstruction only when the results of permanent pathologic evaluation are available. The authors evaluated oncologic safety and cost benefit of single-stage neoplasm extirpation with immediate reconstruction.
  
  
  METHODS
  The authors reviewed all patients treated with biopsy-proven melanoma followed by immediate reconstruction during a 3-year period (January of 2011 to December of 2013). Patient demographic data, preoperative biopsies, operative details, and postoperative pathology reports were evaluated. Cost analysis was performed using hospital charges for single-stage surgery versus theoretical two-stage surgery.
  
  
  RESULTS
  During the study period, 534 consecutive patients were treated with wide excision and immediate reconstruction, including primary closure in 285 patients (55 percent), local tissue rearrangement in 155 patients (30 percent), and skin grafting in 78 patients (15 percent). The mean patient age was 67 years (range, 19 to 98 years), and the median follow-up time was 1.2 years. Shave biopsy was the most common diagnostic modality, resulting in tumor depth underestimation in 30 patients (6.0 percent). Nine patients (2.7 percent) had positive margins on permanent pathologic evaluation. The only variables associated with positive margins were desmoplastic melanoma (p = 0.004) and tumor location on the cheek (p = 0.0001). The mean hospital charge for immediate reconstruction was $22,528 compared with the theoretical mean charge of $35,641 for delayed reconstruction, leading to mean savings of 38.5 percent (SD, 7.9 percent).
  
  
  CONCLUSIONS
  This large series demonstrates that immediate reconstruction can be safely performed in melanoma patients with an acceptable rate of residual tumor requiring reoperation and significant health care cost savings.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Irena
authors.initials: I
authors.lastname: Karanetz
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Sharon
authors.initials: S
authors.lastname: Stanley
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Denis
authors.initials: D
authors.lastname: Knobel
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bastidas
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Beg
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Armen K
authors.initials: AK
authors.lastname: Kasabian
authors.affiliation: New York, N.Y.|From the Divisions of Plastic and Reconstructive Surgery and Surgical Oncology, Northwell Health, Hofstra Northwell School of Medicine.
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D017046:Cost Savings / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008545:Melanoma / Q000191:economics / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms; D013524:Surgical Flaps; D013997:Time Factors; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma