Malignant melanoma in a skin graft: burn scar neoplasm or a transferred melanoma?

Malignant melanomas (MM) arising in burn scars are rare with 16 cases previ ously reported. Malignant melanomas arising on skin grafts are even more ra re with only two cases reported. We present the case of MM arising on a bur ned area that had been previously grafted with a split thickness skin graft . A 19-year-old patient sustained 20% burns in a road traffic accident. The burned areas were debrided and skin grafted. Six months later, the patient developed MM on the left calf (an area that was burned and grafted). The t umour was excised with wide margins. Six months following the excision of t he MM, the patient started to develop multiple dysplastic naevi in the skin grafted burned areas. In the present case, the main question to be answere d is whether the MM arose from the donor or the recipient site of the split thickness skin graft. After thorough discussion of the two options and rev iewing the literature, the authors believe that the MM and the atypical nae vi were transferred to the recipient site with the skin graft. Therefore, i t is suggested that in the process of harvesting skin grafts, any pre-exist ing naevi should be avoided or removed, and if this is not feasible, should be recorded in detail in the operation notes. Also, patients at discharge should be advised that any change in the appearance of the grafts or any ne w lesions in the engrafted areas should be reported to their physicians. (C ) 2000 The British Association of Plastic Surgeons.