This series of photographs represents an approach to margin management of melanoma in situ. Some melanoma in situ margins are difficult to assess clinically, as is the case in our first series with extensively pigmented skin. In some settings, taking 7-9 mm margins exposes the patient to significant healing issues, as the second case shows with lower leg melanoma in situ. In such cases, more conservative margin resection could be performed risking a finding of positive margins. With full thickness skin graft repair, additional margin excision is possible and reasonable.
The first case shows excision and primary closure to the skin graft 5 weeks later. The second case shows the same performed 3 weeks after skin grafting. Both show good healing and resilience of the skin graft with closure under tension.