Wide Local Excision of an Intermediate-Thickness Back Melanoma with a Sentinel Lymph Node Biopsy of Left Axillary Lymph Nodes

1. Introduction

2. Surgical Approach

1. Intradermal Injection of Isosulfan Blue
2. Confirm No In-Transit Nodes with Probe
3. Marking
4. Inject Local Anesthetic

3. Incision

4. Dissection

1. Release Edges
2. Find the Plane
3. Complete the Excision

5. Orientation of the Specimen and Hemostasis

6. Closure

7. Confirm Mapping to the Left Axilla

8. Approach to Sentinel Lymph Node Biopsy

1. Marking
2. Inject Local Anesthetic

9. Incision

10. Dissection

1. Dissect Down to Axillary Fascia
2. Use Probe for Orientation
3. Lift Node with Silk Stitch
4. Dissect out the Node

11. Take Count on the Node

12. Exploration for More Sentinel Lymph Nodes

1. Dissection of Second SLN
2. Dissection of Next Node Cluster: SLN 3 and 4 with Non-Sentinel Nodes
3. Confirm No More Hot Nodes

13. Closure

14. Post-op Remarks