PREOPERATIVE DIAGNOSES:
1. Lymphadenopathy, right neck.
2. History of melanoma, back.
POSTOPERATIVE DIAGNOSES:
1. Lymphadenopathy, right neck.
2. History of melanoma, back (reactive lymph node by frozen section).
PROCEDURE PERFORMED: Excision of deep lymph node, right neck.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old Hispanic male who has previously been treated for 0.84 mm thick, Clark level III melanoma of his back. During followup visit with his dermatologist and to this office, he was noted to have a very prominent lymph node in his right supraclavicular fossa. It was initially reasonably hard and very discrete.
Fine needle aspiration was negative for melanoma and nondiagnostic. CT scanning of the neck and chest revealed no abnormal adenopathy. The lesion, however, remained palpable along with several other nodes in the area, which were prominently palpable. In order to resolve the issue of either underlying recurrent melanoma or a lymphoproliferative disorder, he was brought to the operating room for excision and definitive histologic diagnosis.
OPERATIVE FINDINGS: The most prominent node was removed. It was examined by Dr. John Doe. Frozen section was most consistent with reactive hyperplasia. Several other smaller nodes in the area were also removed. They were all submitted for histologic evaluation with permanent sections. No evidence of infectious problem was found, so the noted tissue was not cultured.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position on the operating room table. General anesthesia was induced. The patient’s neck was hyperextended and turned to the left. The nodes were palpated and carefully marked in the inferior aspect of the left neck. The area was prepped with DuraPrep. Sterile drapes were applied.
An incision was made transversely at the base of the neck. It was taken down through the platysma. In the fatty tissue of the supraclavicular fossa, the first relatively large node was removed. It was sent for evaluation as noted above. Other smaller lymph nodes were removed from the same area. When the node was reported as probably benign and an adequate tissue sample was available, the wound was closed.
The bleeding was controlled with 3-0 Vicryl ties and with cautery. The 3-0 Vicryl sutures were placed in the platysma followed by running 5-0 PDS subcuticular and Dermabond dressing. The patient tolerated this well and was returned to the recovery room in satisfactory condition.
