DIAGNOSTIC STUDIES
An incisional biopsy of the residual lesion on his back is performed. Two-thirds of the macule is removed, the wound is closed with sutures, and the specimen is submitted for pathologic examination. The resulting report indicates a superficial spreading melanoma, Breslow depth (vertical thickness) of 1.6 mm, with evidence of significant regression and a brisk mitotic rate─all predictors of metastatic potential.
Accordingly, the patient is referred to the appropriate surgical specialist, who confirms the micrometastatic nature of the axillary node and refers the patient to oncology for imaging studies that will determine the extent of metastasis. The residual primary tumor is excised with 2-cm margins.
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