61-year-old woman presents with several year history of pigmented left cheek and lower lid lesion. She was initially treated with liquid nitrogen 15 months ago. A biopsy was performed 6-8-17 and revealed melanoma in situ. Excision with close margins performed 6-16-17. Clear margins found on LPMG reading. Second opinion from UCSD was suspicious for involved margins. Excision of melanoma in situ of left lower eyelid and cheek with additional 5mm margins was performed 8-21-17. Pathology showed no evidence of residual melanoma.
Reconstruction of this large cheek and lid defect was performed with 3 partial island flaps. Similar to scalp pinwheel flaps, this reconstructive technique is a tissue sparing method. It also distributes the tension across a large portion of the face. The flaps used were lateral eyelid partial island flap based on inferior palpebral artery, superomedial nasal partial island flap based on lateral nasal and angular arteries, and inferior cheek partial island flap based on branches of the infraorbital artery.