Is It Time to Reconsider the Prognostic Role of Mitotic Rate in Cutaneous Malignant Melanoma? Evidence from a Multicenter Study on Behalf of Italian Melanoma Intergroup

Likewise, the use of BTM on previously irradiated tissues or its durability following adjuvant radiotherapy is not known.Methods: We performed a retrospective review of patients undergoing resection of cutaneous malignancies of the scalp and reconstruction with BTM between February 2020 and February 2024.Reported outcomes included BTM integration, skin graft take, surgical site infection, haematoma, late graft loss, and time to postoperative radiotherapy.Results: 22 patients were included of which 21 (95%) were male, 13 (59%) had squamous cell carcinoma, 6 (27%) melanoma and 3 (14%) basal cell carcinoma.All cases required either primary or subsequent resection down to bone to achieve a negative margin, therefore a skin graft alone was not feasible.Of the remaining patients, 18 (82%) had >80%integration of the BTM and subsequent successful skin graft take.3 (14%) patients developed osteomyelitis, one after BTM application and the others after skin grafting.Of the 4 patients who received adjuvant radiotherapy, 2 developed osteoradionecrosis (ORN) (50%).One patient had radiotherapy prior to BTM application, resulting in ORN.In this patient the BTM failed to integrate and they proceeded to have a free-tissue flap.Conclusions: BTM is a reliable adjunct for the reconstruction of complex scalp wounds following resection of cutaneous malignancies, which cannot be managed with skin grafting alone.However, in patients who have previously-or are likely to undergo radiotherapy to their scalp wounds, BTM appears to be less effective.