# Multidisciplinary Approach to Melanoma: A Case Report on Below-Knee Amputation and Lymph Node Dissection

## TL;DR

A 65-year-old man with diabetes and hypertension underwent surgery for a melanoma in his foot, highlighting the need for multidisciplinary care in complex cancer cases.

## Contribution

This case report emphasizes the value of a multidisciplinary approach in managing melanoma with coexisting chronic conditions.

## Key findings

- The patient underwent successful below-knee amputation and lymph node dissection for melanoma.
- Histopathology confirmed melanoma, but immunohistochemistry showed HMB-45 and S-100 negativity.
- Post-operative recovery was uneventful, underscoring the importance of early diagnosis and surgical intervention.

## Abstract

A 65-year-old male presented with progressive swelling and difficulty in walking due to a right foot sprain. Initial treatments were conducted in Chandrapur, followed by referral to Acharya Vinoba Bhave Rural Hospital for further evaluation and management. The patient, a known case of diabetes mellitus and hypertension, reported an insidious onset of right foot swelling over two months. A physical examination revealed stable vital signs; no significant abnormalities were observed during the systemic examination. Laboratory investigations indicated mild anemia and slightly elevated liver enzymes. Imaging studies, including MRI and CT scan, identified an ill-defined lesion on the medial aspect of the right foot, consistent with dermatofibroma. The patient underwent a below-knee amputation with inguinal lymph node dissection on 31st May 2024. The procedure, performed under spinal and epidural anesthesia, involved meticulous dissection and ligation, with the posterior flap sutured using Ethilon 2-0 (Ethicon, Cincinnati, OH, USA). Post-operative management included IV antibiotics and supportive care. The patient’s postoperative course was uneventful, with a healthy suture line and stable vitals upon discharge. Histopathological evaluation of the resected specimen confirmed melanoma, with immunohistochemistry revealing HMB-45 and S-100 negativity. The patient was discharged with advice on local hygiene, physiotherapy, dietary recommendations, and a follow-up schedule. This case highlights the importance of comprehensive multidisciplinary management in treating malignancies complicated by chronic conditions. Early diagnosis, appropriate surgical intervention, and diligent post-operative care are crucial for favorable outcomes in complex oncological cases.