POSTOPERATIVE
DIAGNOSIS: Malignant melanoma, posterior neck.
PROCEDURE:
Wide excision of
malignant melanoma, posterior neck and complex repair approximately 8 cm.
ANESTHESIA:
0.5% lidocaine with
epinephrine plus Neut.
COMPLICATIONS: None.
INDICATIONS FOR SURGERY: This patient is a 74-year-old white male who recently underwent a biopsy
of a lesion on the posterior side of his neck.
This revealed a malignant melanoma in situ. The patient was advised to have this removed
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 wide excision, and
reconstruction was advised. The surgical
procedure was thoroughly discussed with him including placement of incisions,
scars, the anticipated outcome, and recovery.
The potential risks and complications of the surgical procedure were
thoroughly discussed with him and include, but are not limited to bleeding,
infection, 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. He is 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 he understands. All of his questions were answered and he
gives consent. The mass was identified
and confirmed by the patient in the preoperative holding area.
PROCEDURE IN DETAIL: The patient taken to the operating room,
placed in a left lateral decubitus position, where the area was prepped and
draped using sterile technique. The
biopsy measured about 6 x 7 mm in size.
A 1-cm margin was marked out entirely around the area drawing a circle
close to 2.8 cm in diameter. An ellipse
was drawn along least tension lines and natural skin creases measuring about 8
cm in length and the area was infiltrated with 0.5% lidocaine with epinephrine
plus Neut.
#15 blade was used to carry out the wide
excision through the skin, subcutaneous tissue, and deep subcutaneous tissue
down to the underlying fascia. The
specimen was excised in its entirety and submitted to pathology for permanent
sectioning.
Extensive undermining was performed in a
deep subcutaneous plane in order to allow primary closure of the defect and
obliteration of the dead space.
Meticulous hemostasis was achieved and Gelfoam was also used.
The defect was then closed in layers, using
multiple interrupted buried 3-0 Vicryl sutures to approximate the subcutaneous
tissue and dermis, followed by 4-0 Prolene in a subcuticular fashion. Total length of repair was approximately 8
cm. Mastisol and Steri-Strips were
applied as a 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. He
was informed to call the office if he has any questions or problems.
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