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Objective: Keystone Design Island Flaps (KDIF) were initially described by Behan for cutaneous coverage as an alternative to skin grafts or major flaps. KDIF combines rotation and V-Y advancement and is useful for oncologic or trauma defects. This study analyzes the initial "learning curve" experience with KDIF by one surgeon with significant melanoma experience but no plastic surgical training. Design: Observational Setting: Community tertiary hospital with surgical residency Patients: 47 consecutive patients undergoing 48 KDIF. 39 melanoma, 9 other skin cancers. 50% trunk, 23% upper extremity, 23% lower extremity, 4% head. Cutaneous defect (4.4 - 81 cm2 - mean 29.2 cm2). Age 20-87 (61.8). Interventions: All patients underwent appropriate skin excisions closed by KDIP flap. 67% had sentinel node biopsy at the time of KDIF(16% positive). Main Outcome Measures: Flap loss, skin slough >10%, infection. Results: There were no flap losses, 2 patients (4%) had >10% skin sloughs, 1 (2%) had a delayed partial dehiscence, and 2 (4%) had infections. All complications healed without sequelae. Conclusions: KDIF is an easily mastered flap that can cover relatively large cutaneous defects after oncologic surgery. It can be performed safely by a surgeon without plastic surgery training.