Preoperative work-up

By Mia Wangsmo Steffenssen MD, Mike Mikkelsen Lorenzen, MD and Pia Sjøgren MD

The exact location, size and presentation of the cancer lesion should be documented in the journal. The tumor margins are marked following the preoperative drawing of the surgical excision margin. 

Primary surgery for an undiagnosed melanoma requires direct closure. Should direct closure not be possible the defect should be left open until a definitive diagnosis is procured from the department of pathology is present. Only then should second reconstructive measures such as transplants or flap surgery come into play.

Patient history

Changes in/or new elements. Ulceration or itching in elements

Familiar disposition of MM, previous history of MM

Exposition: excessively sunbathing, solarium, earlier/ongoing immunosuppression treatment, skintype(Fitzpatrick)

Patient co-morbidities

Objective evaluation

Skin is inspected from head to toe, including palms and soles.

The area around the suspected element is inspected and palpated for satellites and in transit metastasis.

Lymph node stations are palpated on head and neck, supra- and infraclavicular, axillary and inguinal/groin.