Use of Integra for thumb length conserving surgery for an acral melanoma in-situ

Abstract

BACKGROUND: Acral melanoma (AM) is an uncommon subtype of melanoma and has traditionally been managed with amputation of the affected digit, even in cases of in-situ disease. Such an approach may result in significant functional and psychological morbidity, particularly in elderly patients.

METHODS: We report the case of an 80-year-old gentleman who presented with an AM in-situ affecting the left thumb, which had been present for over 20 years. Following refusal of amputation, a conservative surgical approach was undertaken. A degloving procedure was performed, and reconstruction was achieved using a dermal regeneration template (Integra®).

RESULTS: Despite the technical and oncological limitations associated with conservative management, the patient achieved a functionally and aesthetically satisfactory outcome, with preservation of thumb length and function.

CONCLUSION: Although amputation of the affected digit has historically been recommended for AM, this case highlights that, in carefully selected patients with in-situ disease, a more conservative surgical approach may be a viable alternative. Such an approach may allow adequate disease control while preserving function and improving quality of life.