A 57-year-old male patient with the initial diagnosis of an advanced malignant melanoma on the left foot was operated in our department with an excision in sano of the tumor and closing of the defect by performing a free anterolateral thigh flap (ALTP). However, diagnostic lymph node biopsy was performed as well and following positive histopathology findings, a groin dissection, which was performed without complications, was necessary. The vascular femoral structures were covered by a transposition of the sartorius muscle. As a matter of fact, the patient could be discharged within five days after an uncomplicated wound healing.\nOver the course of time, chemotherapy and radiotherapy was conducted on the affected groin by the department of dermatology. Unfortunately, positive signs of lymph metastasis were detected in the groin region again, thereby requiring the necessity of another operation for the removal of all stationary lymph nodes and subcutaneous tissue. This time wound healing was prolonged due to the immunocompromised status of the patient and the impaired skin in the groin after radiotherapy. With the formation of a chronic seroma regular puncture was necessary, which led to chronic lympho-edema, recurring erysipelas and a frequent re-hospitalisation of the patient. Finally, we decided together with the patient to re-operate the radiated groin. After several debridements the defect was closed by performing loco-regional advancement flaps. The final wound healing was acceptable with only a small dehiscence and no further seroma so far. Chemotherapy was continued by the department of dermatology after the patient had been discharged.
A 72-year-old woman with the initial diagnosis of a malignant melanoma on the right lower leg presented to our clinic after an in sano excision in a clinic alio loco. However, after further excision of the melanoma, we closed the wound using skin mesh-graft. After complete wound healing, the patient received a low-dose interferon therapy with Roferon. After 3 months, the patients presented to us with worsening of the wound condition and a reappearance of activated melanoma in situ of the scar on the right lower leg. Therefore, a radical excision of the pretibial scar and a temporary covering with alloplastic material was performed. After several debridements, a clean granulating wound could be achieved making it possible to cover the defect of the lower leg with a free radial forearm flap from the right forearm. Finally, the patient could be discharged with normal wound healing from our department and received further chemotherapy without any sign of re-appearance of the malignant melanoma so far.