四肢末端部皮膚悪性腫瘍の切除範囲と再建法

抄録

This article reviews the surgical management for cutaneous malignant neoplasms affecting acral portions, particulary malignant melanoma and squamous cell carcinoma of hand and foot. In most cases, surgical excision is the treatment of choice for primary lesions of cutaneous malignant melanoma and squamous cell carcinoma. In addition to an adequate excision, functional and cosmetic reconstruction are essential in the treatment of the neoplasm of hand and foot.
Based on several randomized sutudies with long-term follow-up, decreased size of the resection margin for cutaneous melanoma has been recommended. The narrow surgical margin not only decreases functional loss but also makes treatment more simple. Correct diagnosis and accurate staging of the disease are important to decide size of the margin, and if necessary, excisional or incisional biopsy should be done even in malignant melanoma.
Although there are many ways of reconstruction of defect after excision of malig-nant neoplasm of hand and foot, our first choice is simple way. Artificial dermis is recently available and useful to close skin defect exposing bone and/or tendon. Split thickness or full thickness skin graft is the most standard technique to close skin defect. Free flaps, such as wrap-aroud flap and pollicization, are good ways to reconstruct thum after its amputaion.
Optimal surgical management with adequate margin associated with appropriate reconstruction is essential for the better quality of life of the patients.