MOHs for melanoma insitu?
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MOHs for melanoma insitu?

› Forums › General Melanoma Community › MOHs for melanoma insitu?

  • Post
    • February 15, 2014 at 12:12 am
    lisa215
    Participant

    Hi, Dr miller at upenn reviewed my pathology report and his office called to schedule me for MOHs surgery. Anyone have experience with MOHs for melanoma stage zero?  I didn't realize it was an option for melankma. Are there advantages or drawbacks over excision? 

Viewing 5 reply threads
  • Replies
      • February 15, 2014 at 1:39 am
      Janner
      Participant

      The advantages of Mohs is that it tries to be tissue saving.  My doc, a cutaneous oncologist and Mohs surgeron, only uses Mohs if the lesion is Lentigo Maligna.  The Lentigo Maligna subtype of melanoma has a high local recurrence rate.  The disadvantage of Mohs over traditional excision is that melanoma cells don't show up very well on "frozen section" pathology.  Mohs uses frozen section.  Traditional excision use paraffin and stains which highlight melanoma cells for easier analysis.  So this is why excision is usually considered a better choice.  However, since the typical recommendations for melanoma are to have 5mm minimum for melanoma in situ, I'd wonder if they are using Mohs just to get "clean margins" or if they plan on getting clean margins plus 5mm?  I've never been clear on that when Mohs is used. 

      Some docs recommend Mohs, but most still do traditional excision for all melanomas.  Since every case is different, it's important to discuss this with your doc and understand the reasoning for their recommendation.  There isn't a "one size fits all" rule when it comes to any of this.

      Best wishes,

      Janner

      • February 15, 2014 at 1:39 am
      Janner
      Participant

      The advantages of Mohs is that it tries to be tissue saving.  My doc, a cutaneous oncologist and Mohs surgeron, only uses Mohs if the lesion is Lentigo Maligna.  The Lentigo Maligna subtype of melanoma has a high local recurrence rate.  The disadvantage of Mohs over traditional excision is that melanoma cells don't show up very well on "frozen section" pathology.  Mohs uses frozen section.  Traditional excision use paraffin and stains which highlight melanoma cells for easier analysis.  So this is why excision is usually considered a better choice.  However, since the typical recommendations for melanoma are to have 5mm minimum for melanoma in situ, I'd wonder if they are using Mohs just to get "clean margins" or if they plan on getting clean margins plus 5mm?  I've never been clear on that when Mohs is used. 

      Some docs recommend Mohs, but most still do traditional excision for all melanomas.  Since every case is different, it's important to discuss this with your doc and understand the reasoning for their recommendation.  There isn't a "one size fits all" rule when it comes to any of this.

      Best wishes,

      Janner

      • February 15, 2014 at 1:39 am
      Janner
      Participant

      The advantages of Mohs is that it tries to be tissue saving.  My doc, a cutaneous oncologist and Mohs surgeron, only uses Mohs if the lesion is Lentigo Maligna.  The Lentigo Maligna subtype of melanoma has a high local recurrence rate.  The disadvantage of Mohs over traditional excision is that melanoma cells don't show up very well on "frozen section" pathology.  Mohs uses frozen section.  Traditional excision use paraffin and stains which highlight melanoma cells for easier analysis.  So this is why excision is usually considered a better choice.  However, since the typical recommendations for melanoma are to have 5mm minimum for melanoma in situ, I'd wonder if they are using Mohs just to get "clean margins" or if they plan on getting clean margins plus 5mm?  I've never been clear on that when Mohs is used. 

      Some docs recommend Mohs, but most still do traditional excision for all melanomas.  Since every case is different, it's important to discuss this with your doc and understand the reasoning for their recommendation.  There isn't a "one size fits all" rule when it comes to any of this.

      Best wishes,

      Janner

        • February 15, 2014 at 2:40 am
        lisa215
        Participant

        Thanks very much, Janner. Your reply was very helpful. I definitely have some follow up questions to ask. The doc that biopsed didn't mention lentigo maligna and my path report doesn't include that language. I haven't actually met the surgeon. All this information is coming from the assistants helping with scheduling. 

        • February 15, 2014 at 2:40 am
        lisa215
        Participant

        Thanks very much, Janner. Your reply was very helpful. I definitely have some follow up questions to ask. The doc that biopsed didn't mention lentigo maligna and my path report doesn't include that language. I haven't actually met the surgeon. All this information is coming from the assistants helping with scheduling. 

        • February 15, 2014 at 2:40 am
        lisa215
        Participant

        Thanks very much, Janner. Your reply was very helpful. I definitely have some follow up questions to ask. The doc that biopsed didn't mention lentigo maligna and my path report doesn't include that language. I haven't actually met the surgeon. All this information is coming from the assistants helping with scheduling. 

        • February 16, 2014 at 3:13 am
        paul Lyons
        Participant

        Hello Lisa,

        I've done MOHs several times — it seems to be most considered for spots on the face that look contained where the extra tissue might make a significant cosmetic difference. I was told they see the melanoma pretty clearly, but that was by a MOHs practitioner, and I'm not sure is wholly supported (or disallowed) by data.

        Paul

        • February 16, 2014 at 3:13 am
        paul Lyons
        Participant

        Hello Lisa,

        I've done MOHs several times — it seems to be most considered for spots on the face that look contained where the extra tissue might make a significant cosmetic difference. I was told they see the melanoma pretty clearly, but that was by a MOHs practitioner, and I'm not sure is wholly supported (or disallowed) by data.

        Paul

        • February 16, 2014 at 3:13 am
        paul Lyons
        Participant

        Hello Lisa,

        I've done MOHs several times — it seems to be most considered for spots on the face that look contained where the extra tissue might make a significant cosmetic difference. I was told they see the melanoma pretty clearly, but that was by a MOHs practitioner, and I'm not sure is wholly supported (or disallowed) by data.

        Paul

        • February 20, 2014 at 12:51 am
        lisa215
        Participant

        Thanks very much, Paul. 

        • February 20, 2014 at 12:51 am
        lisa215
        Participant

        Thanks very much, Paul. 

        • February 20, 2014 at 12:51 am
        lisa215
        Participant

        Thanks very much, Paul. 

        • February 16, 2014 at 3:16 am
        Charlie S
        Participant

        It is important to note that because one poster says their doctor ) a Mohs Surgeon) only employs that technique for Lentigo Melanoma, please be advised that the majority of Mohs Surgeons treat not only lentigo, but basal and squamous celll carcinoma as well as melanoma in-situo ( which by the way is melanoma zero)……which means it is not melanoma.

        http://www.skincancermohssurgery.org/mohs-surgery/

        Please explore Mohs in depth.

        • February 16, 2014 at 3:16 am
        Charlie S
        Participant

        It is important to note that because one poster says their doctor ) a Mohs Surgeon) only employs that technique for Lentigo Melanoma, please be advised that the majority of Mohs Surgeons treat not only lentigo, but basal and squamous celll carcinoma as well as melanoma in-situo ( which by the way is melanoma zero)……which means it is not melanoma.

        http://www.skincancermohssurgery.org/mohs-surgery/

        Please explore Mohs in depth.

        • February 16, 2014 at 3:16 am
        Charlie S
        Participant

        It is important to note that because one poster says their doctor ) a Mohs Surgeon) only employs that technique for Lentigo Melanoma, please be advised that the majority of Mohs Surgeons treat not only lentigo, but basal and squamous celll carcinoma as well as melanoma in-situo ( which by the way is melanoma zero)……which means it is not melanoma.

        http://www.skincancermohssurgery.org/mohs-surgery/

        Please explore Mohs in depth.

        • February 16, 2014 at 4:40 am
        Janner
        Participant

        My doc uses MOHs for all the other skin cancers but in the melanoma arena, only Lentigo Maligna.  MOHs is used most often for the other skin cancers and that was a given.  Lentigo Maligna becomes Lentigo Maligna Melanoma  when it becomes invasive, but that might not be a universal opinion.

        • February 16, 2014 at 4:40 am
        Janner
        Participant

        My doc uses MOHs for all the other skin cancers but in the melanoma arena, only Lentigo Maligna.  MOHs is used most often for the other skin cancers and that was a given.  Lentigo Maligna becomes Lentigo Maligna Melanoma  when it becomes invasive, but that might not be a universal opinion.

        • February 16, 2014 at 4:40 am
        Janner
        Participant

        My doc uses MOHs for all the other skin cancers but in the melanoma arena, only Lentigo Maligna.  MOHs is used most often for the other skin cancers and that was a given.  Lentigo Maligna becomes Lentigo Maligna Melanoma  when it becomes invasive, but that might not be a universal opinion.

        • February 20, 2014 at 12:52 am
        lisa215
        Participant

        Thank you. 

        • February 20, 2014 at 12:52 am
        lisa215
        Participant

        Thank you. 

        • February 20, 2014 at 12:52 am
        lisa215
        Participant

        Thank you. 

      • February 16, 2014 at 10:48 pm
      Cfenton
      Participant

      I will actually be having MOHS in one week for MIS on my scalp. I had an atypical mole removed twice since 2006 and now it is back and MIS.  When I met the surgeon after he biopsy he determined (using a black light device) that there are dark cells (that you can't otherwise see) in a much larger area than the original mole and previous scars. So he is going to perform surgery and somehow stitch me back up, possibly using a piece of skin from another "hair bearing" area of my head. I think in my case, they want to make sure they get it all… but save as much scalp as possible.  I am more nervous than I ever was before. I hope it remains in situ… but I fear I will be "re-staged."

      • February 16, 2014 at 10:48 pm
      Cfenton
      Participant

      I will actually be having MOHS in one week for MIS on my scalp. I had an atypical mole removed twice since 2006 and now it is back and MIS.  When I met the surgeon after he biopsy he determined (using a black light device) that there are dark cells (that you can't otherwise see) in a much larger area than the original mole and previous scars. So he is going to perform surgery and somehow stitch me back up, possibly using a piece of skin from another "hair bearing" area of my head. I think in my case, they want to make sure they get it all… but save as much scalp as possible.  I am more nervous than I ever was before. I hope it remains in situ… but I fear I will be "re-staged."

      • February 16, 2014 at 10:48 pm
      Cfenton
      Participant

      I will actually be having MOHS in one week for MIS on my scalp. I had an atypical mole removed twice since 2006 and now it is back and MIS.  When I met the surgeon after he biopsy he determined (using a black light device) that there are dark cells (that you can't otherwise see) in a much larger area than the original mole and previous scars. So he is going to perform surgery and somehow stitch me back up, possibly using a piece of skin from another "hair bearing" area of my head. I think in my case, they want to make sure they get it all… but save as much scalp as possible.  I am more nervous than I ever was before. I hope it remains in situ… but I fear I will be "re-staged."

        • February 20, 2014 at 12:54 am
        lisa215
        Participant

        Good luck, CFenton!  I'm nervous about the same thing (re-staging).  

        • February 20, 2014 at 12:54 am
        lisa215
        Participant

        Good luck, CFenton!  I'm nervous about the same thing (re-staging).  

        • February 20, 2014 at 12:54 am
        lisa215
        Participant

        Good luck, CFenton!  I'm nervous about the same thing (re-staging).  

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