Wide excision of malignant melanoma, posterior neck and complex repair approximately 8 cm

PREOPERATIVE DIAGNOSIS:  Malignant melanoma, posterior neck.

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.