Short communicationNew technique for in-continuity axillary and supraclavicular lymphadenectomy for advanced metastatic melanoma using intraoperative image guidance: a case reportGajanan, Kantappaa,*; Daga, Karanb,c,*; Mullan, Damianb; Kosutic, Damira Author Information aDepartments of Plastic Surgery bRadiology, The Christie NHS Foundation, Manchester cGuy’s and St. Thomas’ Hospital, London, UK Received 25 June 2022 Accepted 17 October 2022. *Kantappa Gajanan and Karan Daga are joint first authors. Correspondence to Damir Kosutic, MD, PhD, FRCS (Plast), Consultant Plastic and Reconstructive Surgeon, The Christie NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, UK, Tel: +44 (0) 161 918 7054; e-mail: [email protected] Melanoma Research ():10.1097/CMR.0000000000000868, December 28, 2022. | DOI: 10.1097/CMR.0000000000000868 Buy PAP Metrics Abstract Simultaneousinvolvement of the supraclavicular and axillary lymphatic basins is known to occur in metastatic skin cancers. We present the case of a 35-year-old male with metastatic melanoma present in the right neck and axillary lymph nodes. He underwent a combined, in-continuity dissection of both basins using intraoperative ultrasound to ensure full clearance of lymph nodes from the cervicoaxillary canal, which otherwise would have been impossible to achieve without clavicle osteotomy. This allowed us to avoid a division of the clavicle and related morbidity. Postoperative imaging confirmed no residual disease, and no local recurrence subsequently. We conclude that intraoperative use of ultrasound can help guide surgeons trying to achieve clearance of metastatic disease in anatomically complex regions, avoiding unnecessary morbidity. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.