Oncologic Implications of Postoperative Complications in the Surgical Management of Foot Acral Melanoma

Background: Surgical treatment for foot melanoma often requires complex soft tissue reconstruction, increasing the risk of postoperative complications. While the association between postoperative complications and cancer recurrence has been explored in various oncologic fields, evidence in melanoma remains limited. This study aimed to investigate whether postoperative complications influence oncologic outcomes in patients with foot melanoma. Methods: Patients who underwent wide excision and immediate reconstruction for primary foot melanoma between 2006 and 2021 were reviewed. The cohort was divided into two groups based on the presence or absence of postoperative complications. The cumulative incidence of oncologic events was analyzed, and the association between complications and locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS) was assessed. Results: A total of 238 patients were included, with a median follow-up of 54 months. The mean Breslow thickness was 3.4 mm. Free flaps were the most commonly used method of reconstruction, followed by skin grafts and local flaps. Postoperative complications occurred in 46 patients, with delayed wound healing related to skin graft loss being the most frequent. Tumor-related characteristics did not differ between patients with and without complications. Overall, 84 patients experienced disease recurrence. Patients with complications showed significantly higher rates of local and regional lymph node recurrence, along with inferior LRRFS and DFS. These associations remained significant after multivariable adjustment and were more pronounced in patients with advanced tumor stage. Conclusions: Postoperative complications following surgical treatment for foot melanoma may be associated with an increased risk of locoregional tumor recurrence and inferior oncologic outcomes.