What is included in preoperative care of patients with melanoma?

Updated: Jun 28, 2021
  • Author: Jonathan B Heistein, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Evaluate for metastases. Begin this evaluation with a detailed history and physical examination. The most common metastatic sites, in descending order, are the regional lymph nodes, skin and subcutaneous tissue (in-transit lesions), and lungs. Other possibilities include the brain, the liver, and bone.

In the absence of signs or symptoms of metastatic disease after performing the history and physical examination, obtain a chest radiograph. If abnormalities are observed, follow this with a chest CT scan.

Check serum alkaline phosphatase and lactate dehydrogenase levels. If these are abnormal or if the patient has a history of weight loss, anorexia, or abdominal pain, obtain a liver ultrasound, abdominal CT scan, or both.

Any abnormalities in the neurologic examination or a history of headaches, vertigo, numbness, or weakness warrant a head CT scan.

A bone scan also may be indicated for isolated bone pain or an elevated alkaline phosphatase level.

Use lymphoscintigraphy to identify the correct lymph node basin(s) that drain the site of the primary tumor. This is an essential aid in preoperative planning.

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