Melanoma
Brandon Alba, MD, MPH
Resident Physician
Rush University Medical Center
Chicago, Illinois, United States
Brandon Alba, MD, MPH
Resident Physician
Rush University Medical Center
Chicago, Illinois, United States
Allison Coogan, MD
Resident Physician
Rush University Medical Center, United States
George Kokosis, MD
Physician
Rush University Medical Center, United States
David Kurlander, MD
Physician
Rush University Medical Center, United States
Cristina O'Donoghue, MD (she/her/hers)
Physician
Rush University Medical Center
Downers Grove, Illinois, United States
Approximately 30% of all melanoma cases affect the lower extremity (LE). Unique risk factors, such as decreased mobility and complex reconstruction, may predispose LE melanoma patients to venous thromboembolism (VTE) after surgical excision. The purpose of this study was to analyze the risk factors associated with VTE in patients undergoing LE melanoma excision.
Methods:
The PearlDiver-Mariner database, a national insurance claims database with 151 million unique patients, was used to identify patients with LE melanoma who underwent wide local excision. Chi-square and logistic regression tests were used to analyze the effect of variables such as anatomic site, post-excision reconstruction (including skin grafts, local flaps, and free tissue transfer), and timing of reconstruction on the risk of developing VTE.
Results:
Of 29,068 patients with lower extremity melanoma, 0.89% developed VTE after surgical excision. Of 150,012 patients undergoing melanoma excision of any other anatomic site, 0.79% developed VTE (p = 0.095). On logistic regression, melanoma of the LE was associated with an increased odds of postoperative VTE (adjusted odds ratio [aOR] 1.30, 95% CI 1.14 – 1.49). Patients who underwent reconstruction after LE melanoma excision were significantly more likely to develop VTE than those who did not undergo reconstruction (1.74% vs. 0.83%, p < 0001). On logistic regression, reconstruction after LE melanoma excision was associated with an increased odds of VTE (aOR 1.80, 95% CI 1.20 – 2.62). Patients who underwent reconstruction on the same day as LE melanoma excision had an increased risk of VTE compared to those who underwent delayed reconstruction (2.85% vs. 1.30%, p = 0.027). On logistic regression, immediate reconstruction after LE melanoma excision was associated with an increased odds of VTE (aOR = 2.03, 95% CI 1.37 – 2.88).
Conclusions:
Melanoma of the lower extremity was found to be associated with an increased odds of postoperative VTE. Post-excisional reconstruction, specifically immediate reconstruction, was also associated with an increased risk of VTE. Surgical oncologists and plastic surgeons should be aware of this risk and adjust their postoperative VTE-prevention protocols in addition to other individualized patient risk factors. Further research will study the optimal prophylactic anticoagulation protocol in this patient population.