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Melanoma

Procedure Procedure

Introduction

If the pathohistology shows malignant melanoma there is an indication for re-excision. The distance starts from the suture punctures and not the scar.

If the tumor depth is under 1 mm, the re-excision is 5 mm to muscle fascia. (Total distance 10 mm).

If the tumor depth is over 1 mm or if it is not possible to measure tumor depth, re-excision is 15 mm to muscle fascia. (Total distance 20 mm)

Final distance of excision 
is always defined by tumour depth
MM in situ: total excision distance 5 mm
MM   1 mm: total excision distance 10 mm
MM   1 mm: total excision distance 20 mm

If the melanoma was removed by a doctor outside the specialty of plastic surgery, the primary excision distance is unknown. Therefore the primary excision is 0 mm.

E.g: primary excision of SSMM 0.5 mm at general practitioner: 0 mm + 10 mm = Total distance 10 mm.

Re-excision procedure

1

Step 1: Incision

The skin is incised 5 mm from the previous sutures and in a total of 10 mm from the original cancer.

2

Step 2: Dissection

Incision is continued to the deep fascial plane. This can be carried out by scalpel or dissection scissors.

3

Step 3: Dissection

The skin and subcutaneous fat is dissected along the deep fascial plane

4

Step 4: Removal

Complete removal of the area along the deep fascial plane.

  • NOTE: The clamp is placed on an artery

Procedure and cases

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Primary excision

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Sentinel node


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