Radiation Necrosis of Forehead following Melanoma Excision
Bruce A. Kraemer, M.D.
History:
65 year-old male with Stage II Malignant Melanoma previously treated elsewhere over the prior 3 years with wide excision, split thickness skin graft, radiation therapy, a local rotational flap which progressively deteriorated, resulting in a wound of the present size. Patient has used a variety of topical treatments and presently covers it with a dry dressing. Patient is a non-smoker, in otherwise good health and wanted a treatment plan without extensive operative procedures. Prior radiation and pathology records were not obtainable.
Findings:
Full thickness forehead-scalp wound 4 x 2.7 cm with necrotic bone in the base. No gross purulence in wound, regional lymph nodes clinically negative, and no other pigmented lesions of concern.
Diagnosis:
Open Forehead-Temple wound with exposed necrotic bone in a previously radiated wound bed in a patient with Stage II melanoma.
Differential Diagnoses:
Necrotic bone in the wound bed could be due to osteitis, osteomyelitis, or osteoradionecrosis which could be partial or full thickness
Workup Required:
A CT scan was needed to assess the wound bed bone and to assess regional lymph nodes. Debridement of soft tissues and bone with assessment of possible residual melanoma by pathology and for bacterial cultures was also done.
Plan:
After the work up, debridement first with high energy burrs followed by lower energy rongeurs and curettes until healthy punctate bleeding of bone was reached. Wound coverage first with dermal matrix and then full thickness skin graft when the wound bed was covered by healthy granulation tissue?
Expertise Needed:
Reconstructive plastic surgeon.
Treatment: Debridement
Fig. 2. Debridement with, first burr, then rangeour, then curette.
Follow Up:
References
Scalp Avulsaion
Animal Bite to the face
Surgical Excision of Acne Keloidalis Nuchae with Tissue Expansion
https://bestwoundpractice.com/scalp-avulsion/
https://bestwoundpractice.com/2391-2/
https://bestwoundpractice.com/surgical-excision-of-acne-keloidalis-nuchae-with-tissue-expansion/