The Reconstruction of a Massive Occipital Defect With a Bilateral Temporal Advancement Flap Following Advanced Melanoma Resection: A Case Report

Scalp reconstruction following oncological resection is particularly challenging due to limited tissue laxity and the convexity of the region. Large occipital defects must be carefully reconstructed to provide adequate coverage and minimize morbidity. We present the case of a 71-year-old man with stage IV advanced occipital melanoma (Breslow 7 mm, Clark level IV), in which the melanoma was locally excised over a 15 × 15 cm area, resulting in a large defect. A bilateral temporal advancement flap was employed for reconstruction, based on the region of relative laxity and within the subgaleal avascular plane, while the supraorbital and supratrochlear neurovascular bundles were preserved. The patient showed a good postoperative course. This report demonstrates the validity of the bilateral temporal advancement flap as a robust, reliable, and aesthetically satisfactory option for the treatment of large posterior scalp defects, thereby eliminating the need for skin grafting or free tissue transfer.