Toe Melanoma Resection Followed by Immediate V-Y Advancement Flap Reconstruction: A Case Report

Abstract

Background: Melanoma of the distal toe presents both oncologic and reconstructive challenges. Surgical management must achieve adequate tumor excision while preserving toe length, soft-tissue padding, sensation, and function. Local flap reconstruction may be useful in selected distal toe defects, particularly when tissue with similar characteristics is required for coverage.

Case Presentation: A 59-year-old female patient presented with a progressively enlarging pigmented lesion on the distal aspect of the left first toe, which had been present for approximately five years. Surgical excision was performed under general anesthesia with local infiltration. The lesion was resected with a 0.5 cm margin of clinically healthy tissue, resulting in a distal soft-tissue defect of the hallux.

Surgical Management and Outcome: Immediate reconstruction was performed using a V-Y advancement flap designed adjacent to the defect. The flap was advanced to provide local tissue coverage while preserving toe contour and padding. Histopathological examination confirmed infiltrating melanoma with a Breslow thickness of 1 mm, a mitotic index of 1 mitosis/mm², absence of satellite lesions, no lymphovascular or perineural invasion, and tumor-free surgical margins. At postoperative follow-up, the flap remained viable, with satisfactory healing and no reported sensory or functional impairment.

Conclusion: V-Y advancement flap reconstruction may represent a useful option for selected distal toe defects after melanoma excision. This technique provides local tissue coverage with preservation of contour, padding, and function when careful surgical planning and oncologic follow-up are ensured.