Complete excision of right medial eyebrow lesion

PREOPERATIVE DIAGNOSIS:  Papular changing lesion, right medial brow.

POSTOPERATIVE DIAGNOSIS:  Papular enlarging lesion right medial brow.

OPERATION PERFORMED:  Complete excision of right medial eyebrow lesion with complex repair, total length 1 cm, lesion measured approximately 6 mm in diameter.

OPERATIVE INDICATIONS:  The patient is a 54-year-old hospital employee at West Boca Medical Center who was concerned about a several-month history of enlarging lesion to her right medial brow.  She presented to her dermatologist, who recommended plastic surgical excision.  It is for this reason that she presents today.  It is a papular lesion, raised, palpable, and fairly discreet.  It is unclear whether it is mobile.

The findings discussed with the patient preoperatively.  I informed her that essentially this lesion can be excised, however, we are turning off this lesion for a scar, only time will tell how significant that scar will be.  In this manner, realistic expectations were provided.  I discussed potential complications included, but not limited to bleeding, infection, dehiscence to wound, all of which may require further procedures.  Depending on pathology reports, she may require further excisions.  As stated, I again reminded her of the scar today in the preoperative holding area.  Despite this, however, she wishes that I proceed.

PROCEDURE IN DETAIL:  The patient was taken to main operating room, placed supine on the operating table.  The entire area prepped and draped in _____ standard fashion.  A 1% lidocaine with epinephrine used for local anesthesia.  After satisfactory local anesthesia, chief complete excision carried out, using a 15C scalpel blade.  Operative findings revealed what appears to be an epidermal inclusion cyst.  It was completely excised including a cyst wall.  Specimen was sent to the Pathology including the overlying skin as it was densely adherent.  Irrigation carried out, hemostasis assured using low-power needle-tip cautery.  Reapproximation of deep and dermal layer performed using interrupted 7-0 Vicryl suture.  Skin closed using interrupted 7-0 Prolene suture.  Mastisol and Steri-Strips applied.  The patient tolerated the procedure well without complications.  She was transferred back to recovery room in good condition.  Estimated blood loss minimal.  All sponge, instruments, and needle counts correct.