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  • 1. Introduction
  • 2. Surgical Approach
  • 3. Incision
  • 4. Dissection
  • 5. Orientation of the Specimen and Hemostasis
  • 6. Closure
  • 7. Confirm Mapping to the Left Axilla
  • 8. Approach to Sentinel Lymph Node Biopsy
  • 9. Incision
  • 10. Dissection
  • 11. Take Count on the Node
  • 12. Exploration for More Sentinel Lymph Nodes
  • 13. Closure
  • 14. Post-op Remarks
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Wide Local Excision of an Intermediate-Thickness Back Melanoma with a Sentinel Lymph Node Biopsy of Left Axillary Lymph Nodes

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Kailan Sierra-Davidson, MD, DPhil1; Ogonna N. Nnamani Silva, MD2; Sonia Cohen, MD, PhD1
1Massachusetts General Hospital
2Brigham and Women's Hospital

General Surgery
Main TextProcedure OutlineTranscript

Procedure Outline

Table of Contents

  1. 1. Introduction
  2. 2. Surgical Approach
  3. 3. Incision
  4. 4. Dissection
  5. 5. Orientation of the Specimen and Hemostasis
  6. 6. Closure
  7. 7. Confirm Mapping to the Left Axilla
  8. 8. Approach to Sentinel Lymph Node Biopsy
  9. 9. Incision
  10. 10. Dissection
  11. 11. Take Count on the Node
  12. 12. Exploration for More Sentinel Lymph Nodes
  13. 13. Closure
  14. 14. Post-op Remarks
  1. Intradermal Injection of Isosulfan Blue
  2. Confirm No In-Transit Nodes with Probe
  3. Marking
  4. Inject Local Anesthetic
  1. Release Edges
  2. Find the Plane
  3. Complete the Excision
  1. Marking
  2. Inject Local Anesthetic
  1. Dissect Down to Axillary Fascia
  2. Use Probe for Orientation
  3. Lift Node with Silk Stitch
  4. Dissect out the Node
  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