› Forums › General Melanoma Community › Advice wanted on excision margins
- This topic has 21 replies, 5 voices, and was last updated 7 years, 6 months ago by
cancersnewnormal.
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- November 1, 2016 at 2:21 am
Hello,
This is my first time posting and I'm hoping to get some advice on my most recent diagnosis.
I have just been diagnosed with my 6th Melanoma. My first one 15 years ago was quite deep (3+mm) but with no spread. The second was 1.2mm and 3rd in-situ (2011), then 3 this year have been in-situ. I understand the recommended excision margins for in-situ are 5mm, but I've opted out of this for the most recent two (biopsies had a small 1-2mm clearance). This is against the Drs recommendation, although he has told me that in-situ can not become invasive and at worst, there is the chance of local recurrance, in which case I would opt for an excision. I'm 38 years old and he's never come across anyone my age that hasn't had those extra margins cleared (he's had older patients opt out).
My reasoning behind not going ahead with the further excision is because of my emotional/mental wellbeing — I just don't feel I can be cut into again this year! (3 biopsies + 1 wider excision). That may sound silly (as I know there are people going through much worse than this) or even reckless, but for some reason it's hit me really hard and I've been suffering with panic attacks and anxiety because of it.
I guess my question is — am I being completely reckless not having this done? Is there anybody out there, or any statistics that back this up, whether in-situ can become invasive. I feel there is so much conflicting information out there, and at the same time no answers to this subject, and Melanoma as a whole… it's frustrating and scary.
I hope someone can offer some advice here.
Thank you.
- Replies
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- November 1, 2016 at 3:06 am
Surgery at an early stage is, to date, the only cure for melanoma. In situ is not a 100% guarantee of no spread. I don't think you can guarantee only a local recurrence if not every cell was removed. Most likely? Yes. Guarantee? No. Can you live with yourself if one of these lesions were to progress?
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- November 1, 2016 at 3:06 am
Surgery at an early stage is, to date, the only cure for melanoma. In situ is not a 100% guarantee of no spread. I don't think you can guarantee only a local recurrence if not every cell was removed. Most likely? Yes. Guarantee? No. Can you live with yourself if one of these lesions were to progress?
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- November 1, 2016 at 3:06 am
Surgery at an early stage is, to date, the only cure for melanoma. In situ is not a 100% guarantee of no spread. I don't think you can guarantee only a local recurrence if not every cell was removed. Most likely? Yes. Guarantee? No. Can you live with yourself if one of these lesions were to progress?
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- November 2, 2016 at 5:37 am
That's exactly why it's been so difficult to go against the grain here. I've been weighing up the risk vs my emotional wellbeing. The location of all 3 have left me unable to move freely which has not only impacted my overall health but work too (I'm self employed). They were excised with clear margins (although minimal) in initial biopsy, and I guess I was hoping for a better answer from the Dr than "it's industry standard". Thanks for your comment, I appreciate it.
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- November 2, 2016 at 5:37 am
That's exactly why it's been so difficult to go against the grain here. I've been weighing up the risk vs my emotional wellbeing. The location of all 3 have left me unable to move freely which has not only impacted my overall health but work too (I'm self employed). They were excised with clear margins (although minimal) in initial biopsy, and I guess I was hoping for a better answer from the Dr than "it's industry standard". Thanks for your comment, I appreciate it.
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- November 2, 2016 at 5:37 am
That's exactly why it's been so difficult to go against the grain here. I've been weighing up the risk vs my emotional wellbeing. The location of all 3 have left me unable to move freely which has not only impacted my overall health but work too (I'm self employed). They were excised with clear margins (although minimal) in initial biopsy, and I guess I was hoping for a better answer from the Dr than "it's industry standard". Thanks for your comment, I appreciate it.
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- November 1, 2016 at 5:15 am
Hi
Firstly, I empathise – I, too, developed anxiety/panic around having excision after excision after excision… that mental angst is real, and it's just as crippling as a melanoma diagnosis. That said, three in situs is GREAT NEWS!!! I know that sounds bizarre, but an in situ excision is nothing, a walk in the park, totally a formality as you know the thing is unlikely to spread. Can you just find – or get someone to help you find – the mental fortitude to have those excisions done? You've done it before, you can do it again. Yes, it's a horrible few hours, but a 0.5cm excision is really a whole different thing than 1cm or 2cm WLEs. I would do two things: see a counsellor about panic/anxiety and how to cope, and get those excisions done (maybe ask for a twilight or even general anaesthetic? It could be justified because of anxiety? I wish you strength and 100% understand your predicament, but I would err towards getting those excisions done and dusted.
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- November 2, 2016 at 5:50 am
It's nice to know I'm not alone with the anxiety. It was strange because I had more anxiety this year with the in-situ's, than I ever did with the 3 others (which were much more dangerous). The main reason I didn't want them re-excised was that I feel like my overall wellbeing needs to take priority right now. Risky, perhaps, but that's what I was hoping to get more clarity around — what are the risks of not having those margins cleared. Both biopsies have come back with clear margins (albeit 1-2mm). The position of one was top of the foot which was very tight even with the biopsy, so that was taken into consideration too. I want (need!) to exercise now after having so many months being sedentary. I really appreciate your comment and it's nice to be here on such a supportive forum … although really none of us want to be here, right? Thank you so much.
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- November 2, 2016 at 5:50 am
It's nice to know I'm not alone with the anxiety. It was strange because I had more anxiety this year with the in-situ's, than I ever did with the 3 others (which were much more dangerous). The main reason I didn't want them re-excised was that I feel like my overall wellbeing needs to take priority right now. Risky, perhaps, but that's what I was hoping to get more clarity around — what are the risks of not having those margins cleared. Both biopsies have come back with clear margins (albeit 1-2mm). The position of one was top of the foot which was very tight even with the biopsy, so that was taken into consideration too. I want (need!) to exercise now after having so many months being sedentary. I really appreciate your comment and it's nice to be here on such a supportive forum … although really none of us want to be here, right? Thank you so much.
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- November 2, 2016 at 5:50 am
It's nice to know I'm not alone with the anxiety. It was strange because I had more anxiety this year with the in-situ's, than I ever did with the 3 others (which were much more dangerous). The main reason I didn't want them re-excised was that I feel like my overall wellbeing needs to take priority right now. Risky, perhaps, but that's what I was hoping to get more clarity around — what are the risks of not having those margins cleared. Both biopsies have come back with clear margins (albeit 1-2mm). The position of one was top of the foot which was very tight even with the biopsy, so that was taken into consideration too. I want (need!) to exercise now after having so many months being sedentary. I really appreciate your comment and it's nice to be here on such a supportive forum … although really none of us want to be here, right? Thank you so much.
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- November 2, 2016 at 8:03 am
No, you're definitely not alone with the anxiety! However, I don't think you'll find anyone in the melanoma world who will let you off the hook for those WLEs…. we are all pretty committed to best practice, and right now best practice is to do the WLE. How about you get a good friend, get them to go with you/help calm you, get anaesthetic… just do whatever you've got to do for one horrible day then it's done. It's seriously just one bad day. Once it's done, as you know, there's a bit of pain but you are over the hurdle of having it done and on the road to recovery. Fortune has been kind to you friend, three in situs, this is good, good news (not as good as having no melanoma, of course!). Now just the final step, the WLEs and hopefully your last ever. Good luck!
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- November 2, 2016 at 8:03 am
No, you're definitely not alone with the anxiety! However, I don't think you'll find anyone in the melanoma world who will let you off the hook for those WLEs…. we are all pretty committed to best practice, and right now best practice is to do the WLE. How about you get a good friend, get them to go with you/help calm you, get anaesthetic… just do whatever you've got to do for one horrible day then it's done. It's seriously just one bad day. Once it's done, as you know, there's a bit of pain but you are over the hurdle of having it done and on the road to recovery. Fortune has been kind to you friend, three in situs, this is good, good news (not as good as having no melanoma, of course!). Now just the final step, the WLEs and hopefully your last ever. Good luck!
-
- November 2, 2016 at 8:03 am
No, you're definitely not alone with the anxiety! However, I don't think you'll find anyone in the melanoma world who will let you off the hook for those WLEs…. we are all pretty committed to best practice, and right now best practice is to do the WLE. How about you get a good friend, get them to go with you/help calm you, get anaesthetic… just do whatever you've got to do for one horrible day then it's done. It's seriously just one bad day. Once it's done, as you know, there's a bit of pain but you are over the hurdle of having it done and on the road to recovery. Fortune has been kind to you friend, three in situs, this is good, good news (not as good as having no melanoma, of course!). Now just the final step, the WLEs and hopefully your last ever. Good luck!
-
- November 1, 2016 at 5:15 am
Hi
Firstly, I empathise – I, too, developed anxiety/panic around having excision after excision after excision… that mental angst is real, and it's just as crippling as a melanoma diagnosis. That said, three in situs is GREAT NEWS!!! I know that sounds bizarre, but an in situ excision is nothing, a walk in the park, totally a formality as you know the thing is unlikely to spread. Can you just find – or get someone to help you find – the mental fortitude to have those excisions done? You've done it before, you can do it again. Yes, it's a horrible few hours, but a 0.5cm excision is really a whole different thing than 1cm or 2cm WLEs. I would do two things: see a counsellor about panic/anxiety and how to cope, and get those excisions done (maybe ask for a twilight or even general anaesthetic? It could be justified because of anxiety? I wish you strength and 100% understand your predicament, but I would err towards getting those excisions done and dusted.
-
- November 1, 2016 at 5:15 am
Hi
Firstly, I empathise – I, too, developed anxiety/panic around having excision after excision after excision… that mental angst is real, and it's just as crippling as a melanoma diagnosis. That said, three in situs is GREAT NEWS!!! I know that sounds bizarre, but an in situ excision is nothing, a walk in the park, totally a formality as you know the thing is unlikely to spread. Can you just find – or get someone to help you find – the mental fortitude to have those excisions done? You've done it before, you can do it again. Yes, it's a horrible few hours, but a 0.5cm excision is really a whole different thing than 1cm or 2cm WLEs. I would do two things: see a counsellor about panic/anxiety and how to cope, and get those excisions done (maybe ask for a twilight or even general anaesthetic? It could be justified because of anxiety? I wish you strength and 100% understand your predicament, but I would err towards getting those excisions done and dusted.
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- November 3, 2016 at 8:26 pm
I have a tennis ball size hole on the back of my head near my crown. Took 3 surguries to get a 1 cm clearance and 2 plastic surguries to put skin back over my skull. And talk about a lot of surguries this all happened starting one week after total knee joint replacement. I looked so messed up with badages everywhere that one day in HEB sitting in a cart a manager walked up and said a customer wanted me to have this $100.00 gift card. To me if you are going to have 2mm and hope you get it all just go for more and make sure. Even with the 1 cm a year later I had 1 met in my neck removed by surgury and I have 7 mets in my lungs that I am being treated for. I don't worry about the hole in my head, I just tell people I got shot because I had a melanoma on my forehead also so it looks like the bullet went in my front and came out the back, grandkids believe it.
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- November 3, 2016 at 8:26 pm
I have a tennis ball size hole on the back of my head near my crown. Took 3 surguries to get a 1 cm clearance and 2 plastic surguries to put skin back over my skull. And talk about a lot of surguries this all happened starting one week after total knee joint replacement. I looked so messed up with badages everywhere that one day in HEB sitting in a cart a manager walked up and said a customer wanted me to have this $100.00 gift card. To me if you are going to have 2mm and hope you get it all just go for more and make sure. Even with the 1 cm a year later I had 1 met in my neck removed by surgury and I have 7 mets in my lungs that I am being treated for. I don't worry about the hole in my head, I just tell people I got shot because I had a melanoma on my forehead also so it looks like the bullet went in my front and came out the back, grandkids believe it.
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- November 4, 2016 at 2:22 pm
Oh my gah… Hukill… I am sorry to hear that after having such a big hole torn in your head, it progressed to your lungs anyway. BUT… I have to thank you for the laugh… "I just tell people I got shot". 🙂 I'm going to have to come up with some way cooler stories for my dents and scars! ha ha ha!
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- November 4, 2016 at 2:22 pm
Oh my gah… Hukill… I am sorry to hear that after having such a big hole torn in your head, it progressed to your lungs anyway. BUT… I have to thank you for the laugh… "I just tell people I got shot". 🙂 I'm going to have to come up with some way cooler stories for my dents and scars! ha ha ha!
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- November 4, 2016 at 2:22 pm
Oh my gah… Hukill… I am sorry to hear that after having such a big hole torn in your head, it progressed to your lungs anyway. BUT… I have to thank you for the laugh… "I just tell people I got shot". 🙂 I'm going to have to come up with some way cooler stories for my dents and scars! ha ha ha!
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- November 3, 2016 at 8:26 pm
I have a tennis ball size hole on the back of my head near my crown. Took 3 surguries to get a 1 cm clearance and 2 plastic surguries to put skin back over my skull. And talk about a lot of surguries this all happened starting one week after total knee joint replacement. I looked so messed up with badages everywhere that one day in HEB sitting in a cart a manager walked up and said a customer wanted me to have this $100.00 gift card. To me if you are going to have 2mm and hope you get it all just go for more and make sure. Even with the 1 cm a year later I had 1 met in my neck removed by surgury and I have 7 mets in my lungs that I am being treated for. I don't worry about the hole in my head, I just tell people I got shot because I had a melanoma on my forehead also so it looks like the bullet went in my front and came out the back, grandkids believe it.
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