Vitiligo surgery: melanocyte transfer for stable patches
When a patch has been stable for a year and has not responded to light, moving melanocytes into it is the logical next step.
Medical treatment of vitiligo works by encouraging melanocytes to migrate from hair follicles into depigmented skin. Where there are no follicular reservoirs, such as the lips, fingertips and long standing patches, no amount of light or topical therapy will repigment the area. Surgery transplants melanocytes directly and is the accepted approach for stable, refractory disease [1].
Key points
- Requires disease stability, generally no new or expanding patches for at least twelve months
- Best results in segmental vitiligo and in stable focal patches
- Techniques include punch grafting, suction blister grafting and non cultured cell suspension
- Repigmentation of over seventy five percent is achieved in a majority of well selected patients
- Not suitable for active or unstable disease, where surgery can trigger new lesions
Confirming stability
Stability is the single most important selection criterion. Signs of activity include new patches, enlargement of existing patches, trichrome or confetti like borders and the Koebner phenomenon, where lesions appear at sites of trauma. Operating on active disease can cause depigmentation at the donor site as well as failure at the recipient site [2].
Most surgeons require twelve months of documented stability with serial photographs. A test graft in a small area is a practical way to confirm both stability and the likely cosmetic result.
The main techniques
Miniature punch grafting takes small punches from the donor site, usually the buttock or thigh, and places them into recipient punch holes spaced a few millimetres apart. It is simple and inexpensive but can leave a cobblestone appearance.
Suction blister epidermal grafting raises blisters on the donor site with negative pressure, and the blister roof containing melanocytes is transferred onto a dermabraded recipient site. Colour match is usually excellent. Non cultured epidermal cell suspension, sometimes called melanocyte keratinocyte transplantation, processes a small donor sample into a cell suspension that can cover an area up to ten times larger, which is the technique of choice for larger patches [1].
- Punch grafting: small patches, simple equipment, risk of cobblestoning
- Suction blister grafting: excellent colour match, limited area per session
- Cell suspension: covers larger areas, requires laboratory preparation
- Follicular unit grafting: useful for leukotrichia in the patch
Results and aftercare
Pigment begins to spread from the graft after four to six weeks and continues over six months. Published series report more than seventy five percent repigmentation in the majority of patients with stable segmental disease, with less predictable results on the fingertips, ankles and lips.
The recipient site is immobilised with dressings for a week. Sun protection, and often narrowband UVB or excimer treatment afterwards, help the transplanted melanocytes spread and blend the colour.
Risks
Graft failure, imperfect colour match, cobblestoning, milia, scarring or keloid at donor or recipient site, and perigraft halo of depigmentation. Infection is uncommon with good technique.
The most serious risk is operating on unstable disease, which can spread depigmentation, so careful assessment always precedes surgery.
Frequently asked questions
How do I know if my vitiligo is stable?
No new or growing patches for at least a year, judged with photographs rather than memory. Your dermatologist will also look for signs of activity at the borders.
Can the whole body be treated?
No. Surgery suits limited, stable areas. Extensive vitiligo is managed medically, and in some cases the discussion turns to depigmentation of remaining normal skin instead.
Will the colour match exactly?
Usually close, sometimes slightly lighter or darker at first, and it typically blends over several months with sun exposure and phototherapy.
References
- [1] Mulekar SV, Isedeh P. Surgical interventions for vitiligo: an evidence based review. British Journal of Dermatology. Source
- [2] Taieb A, Picardo M, et al. Guidelines for the management of vitiligo. British Journal of Dermatology. Source
This content is general medical education and does not replace a personal consultation. Any prescription must be coordinated with your local doctor.
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