Excision of atypical melanocytic proliferation abdomen

PREOPERATIVE DIAGNOSIS:

1.  Moderately atypical melanocytic proliferation, abdomen.

2.  Moderately-to-severely atypical melanocytic proliferation, left tibia.

POSTOPERATIVE DIAGNOSIS:

1.  Moderately atypical melanocytic proliferation, abdomen.

2.  Moderately-to-severely atypical melanocytic proliferation, left tibia.

OPERATION PERFORMED:

1.  Excision of atypical melanocytic proliferation abdomen and complex repair approximately 3 cm.    

2.  Excision of moderately-to-severely atypical melanocytic proliferation left tibia and complex repair approximately 4 cm.

ANESTHESIA:  Lidocaine 0.5% with epinephrine plus Neut.

COMPLICATIONS:  None.           

INDICATIONS FOR SURGERY:  This patient is a 38-year-old white female with a history of atypical melanocytic lesions who recently underwent several biopsies and treatments by her dermatologist.  She was referred specifically to my office because of these two areas; one on the left side of the abdomen revealing moderately atypical melanocytic proliferation and one on the medial aspect of the left tibia near the knee revealing moderately-to-severely atypical melanocytic proliferation.  The patient was advised to have these treated and was referred to my office for further evaluation and management.  A full consultation was provided to the patient in the office discussing options for treatment, and she has elected to undergo excision and repair.  The potential risks and complications of the surgical procedure were thoroughly discussed with her and include but are not limited to bleeding, infections, scarring, asymmetry, deformity, recurrence, problems with healing, hypo or hyperpigmentation, hypertrophic or keloid scarring, widening of the scar, donor site morbidity and scarring, and the need for further surgery.  She was fully informed that there will be scars.  Scars are permanent, and no guarantees can be given as to the final outcome appearance, location, or length of the scars.  The patient states she understands.  All of her questions were answered, and she gives consent.  Both biopsy sites were identified and confirmed by the patient in the preoperative holding area.                                         

PROCEDURE IN DETAIL:  The patient was taken to the Operating Room, placed in a supine position where both areas were prepped and draped using sterile technique.  Both areas had a biopsy measuring about 5 mm in diameter, and 5-mm margins were marked out around both lesions.  Ellipses were drawn along these tension lines, and the ellipse on the abdomen measured about 3 cm, and the one on the tibia area measured about 4 cm in order to allow the scar to lie along the contour of the medial tibia and knee area.  Both the areas were infiltrated with 0.5% lidocaine with epinephrine plus Neut.

Both areas were operated on in similar fashion using a 15 blade to excise each specimen through skin and superficial subcutaneous tissue.  Each was excised separately and submitted to Pathology and labeled separately.

Both areas were then repaired in a similar fashion by performing extensive undermining in a superficial subcutaneous plane in order to allow primary closure of the defect.  Meticulous hemostasis was achieved.

Each defect was closed using multiple interrupted buried 4-0 Vicryl sutures to approximate the subcutaneous tissue in the dermis followed by 4-0 Prolene in a subcuticular fashion.  Length of repair on the abdomen was 3 cm and on the left tibia 4 cm.  Mastisol and Steri-Strips were applied as dressing.  The patient tolerated the procedure well.

The patient was given written and verbal instructions in regards to wound care, signs and symptoms of infection, and followup.  She was informed to call the office if she has any questions or problems.