Plantar melanoma of the lateral most aspect of the RT 5th toe near the ball of the foot. It extends laterally and up onto the dorsum of the foot as well as onto the lateral inferior and superior aspects and lateral aspects of the right fifth toe. Presenting for wide excision.
Procedure:
A 1cm measured margin was taken in all directions around the pigmented portion of the melanoma with the exception of the toe. When I measured 1cm margin there, the entirety of the skin of the toe would have needed to be excised. So, after consultation with the plastic surgeons, we elected to excise the entire toe to diminish the risk of local recurrence, so an incision was made longitudinally between the fourth and fifth toe. The incision was extended down into the plantar surface of the foot, staying away from the pigmented portion of the lesion. This was brought to the mid foot laterally and extended up on to the dorsum of the foot and carried down forward to join with the original incision between the toes. The dissection was then carried down between the toes. The digital vessels going to the fifth toe were identified, clamped proximally, divided and then ligated with 4-0 vicryl suture. The metatarsophalangeal joint was then opened through the capsule, the entire metatarsal was saved, but the distal phalanx was disarticulated. The extensor tendon was incised as was the flexor tendon during this process and the toe was amputated, removed en bloc with the skin specimen. With removal, the size of the excision was 7X7cm. Some of the fat pad on the plantar surface of the lateral aspect of the foot was then mobilized and sutured in place to the tissue on the dorsum of the foot covering the entire end of the 5th metatarsal. At this point, the wound was irrigated, hemostasis achieved and plastic surgeon cam in to perform the first portion of the reconstruction of the foot.