I KNOW THIS IS A LOT BUT IT MEANS A LOT TO ME!!!!!!!!!
My brother recently had a Melanoma on his back removed. It had a Breslow level of 0.45mm. An anatomic Clark level of III, and no ulceration was identified. Peripheral margins uninvolved by invasive melanoma. Distance of invasic melanoma from closest periphral margin: 1.4mm. Peripheral margins uninvolved by melanoma in situ. Distance of melanoma in situ from closest peripheral margin 0.9mm. Deep margin uninvolved by invasive melanoma. Distance of invasive melanoma from deep margin: 0.5. mm.
Mitotic rate: None.
Lymph-vascular invasion: Not identified.
Microsatellitosis: Not identified.
Perineural invasion: Not identified.
Tumor-infiltrating lymphocytes:Not idenfitied
Growth phase: Radial and vertical
Pathologic Staging PT1A.
Above is the original diagnosis and below is the description of the procedure that my brother had earlier today. This is ALL new to me and I was wondering if the surgery below seems to be the best approach to this sort of melanoma case. I am reaching out to anyone to share any info. I am most curious to know whether you guys think that the doctor got the entire melanoma and if all of the margins were removed according to the description.
PREOPERATIVE INDICATION: Melanoma on back.
PREOPERATIVE DIAGNOSIS: Melanoma on back.
POSTOPERATIVE DIAGNOSIS: Melanoma on back.
PROCEDURE: 1. Excisional biopsy of a malignant lesion on the back measuring 3.2 cm in maximum diameter including the margins.
2. Complex closure on the back measuring 8 cm.
DESCRIPTION OF PROCEDURE: Estimated Blood Loss: 2 mL.
Indication for Procedure: This is a 22-year-old male that came to my Plastic Surgery Clinic. He had a biopsy here at Mayo Clinic, it was read as a melanoma with a less than 1 mm depth on a shave biopsy, and no worrisome features. The plan was to do a re-excision with 1 cm margins. I met with the patient in the preop area today. We had the opportunity to review the procedure in detail including the risks,
benefits, advantages, disadvantages and alternatives.
The patient had the opportunity to have all questions answered. The patient indicated to me understanding of the material as presented and voluntarily consented to have this procedure performed. Both verbal and written consent were obtained for surgery.
Description of Procedure: The patient was taken to the minor treatment room. He was prepped and draped in a sterile fashion. The edges of the lesion were marked under loop magnification, 1 cm margins were taken all the way around that. It was converted to an ellipse to include a shave biopsy just adjacent as well so that would not be on the healing edge of the incision to close. Next, 1% lidocaine with epinephrine was used to infiltrate the area. After sufficient time had passed for the local anesthetic to take effect, a 15 blade was used to excise the lesion all the way down to the fascia. It was marked at the 12 o'clock position and sent to Pathology for permanent section. Hemostasis was achieved with electrocautery. It was then undermined significantly and sufficiently to allow for tension-free closure. The edges were advanced and then quilting sutures were placed with 3-0 Vicryl, deep dermal stitches were placed with 3-0 Vicryl , and 3-0 Monocryl was run as an intracuticular stitch. Then the final layer of the closure was with Dermabond. Patient tolerated the procedure with no complications, discharged in stable condition, given a followup appointment for just p.r.n. but told with any questions or concerns to follow up sooner.
.
