› Forums › General Melanoma Community › Diagnosed with Melanoma-Insitu
- This topic has 8 replies, 2 voices, and was last updated 13 years, 5 months ago by
Janner.
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- April 16, 2011 at 3:45 pm
I was just diagnosed with melanoma in-situ clark level 1 on my right cheek. The shave biopsy they sent was .5cm X .5cm. It said the cells were only on the epidermis. They have referred me to a plastic surgeon and said I didn't need to see an oncologist. Has anyone had this on their face and if so how much more did they have to take out. They said once they go back in that is usually all you will need to have done except getting checked every 6 months or so. I'm worried about the scarring and just wanted to hear others experiences.
I was just diagnosed with melanoma in-situ clark level 1 on my right cheek. The shave biopsy they sent was .5cm X .5cm. It said the cells were only on the epidermis. They have referred me to a plastic surgeon and said I didn't need to see an oncologist. Has anyone had this on their face and if so how much more did they have to take out. They said once they go back in that is usually all you will need to have done except getting checked every 6 months or so. I'm worried about the scarring and just wanted to hear others experiences. Thanks!
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- April 16, 2011 at 4:10 pm
Standard of care for in situ is 5 mm or .5 cm margins.
Congratulations for catching this so early! In situ has virtually 100% 5 and 10 year survival.
Michel stage 1b.
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- April 16, 2011 at 5:26 pm
Also, now that I think about it, you may wish to discuss a procedure called MOHS. I have heard and discussed with two other people in the past that have had this done of their face for in situ melanoma. My derm does it, but not all can perform this surgery due to the difficulty and skill involved. Physicians that perform Mohs Micrographic Surgery are highly trained in cancer resection, skin pathology and reconstruction. Physicians certified as Mohs surgeons by the American College of Mohs Micrographic Surgery and Cutaneous Oncology have already obtained board certification in either Dermatology or Plastic Surgery and have further certified training by the American College of Mohs Micrographic Surgery and Cutaneous Oncology as Mohs surgeons. Only physicians who have completed a residency in dermatology or plastic surgery are qualified for Mohs Micrographic Surgery training. These individuals have undertaken fellowship level training, for a minimum of a year, at an American College of Mohs Micrographic Surgery and Cutaneous Oncology qualified training centre.
Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate. It has been used in the removal of melanoma-in-situ (cure rate 77% to 98% depending on surgeon) Because the Mohs procedure is micrographically controlled, it provides precise removal of the cancerous tissue, while healthy tissue is spared. Mohs surgery is relatively expensive when compared to other surgical modalities. However, in anatomically important areas (eyelid, nose, lips), tissue sparing and low recurrence rate makes it a procedure of choice by many physicians.
You can read up on it here:
http://en.wikipedia.org/wiki/Mohs_surgery
Michael
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- April 16, 2011 at 8:29 pm
Michael,
Not sure how all Moh's surgeons feel about it, my my cutaneous onc is also a Moh's surgeon. He will only do Mohs on Lentigo Maligna, not any other type of melanoma in situ. Since Lentigo Maligna is notorious for having local recurrences, they will do Mohs. But he told me that since frozen section techniques used in Mohs do not highlight melanocytes well (stains do better), that he only uses it on Lentigo Maligna. As I said, though, this is one Mohs surgeon's opinion and I'm not sure how universal it is.
Janner
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- April 16, 2011 at 8:29 pm
Michael,
Not sure how all Moh's surgeons feel about it, my my cutaneous onc is also a Moh's surgeon. He will only do Mohs on Lentigo Maligna, not any other type of melanoma in situ. Since Lentigo Maligna is notorious for having local recurrences, they will do Mohs. But he told me that since frozen section techniques used in Mohs do not highlight melanocytes well (stains do better), that he only uses it on Lentigo Maligna. As I said, though, this is one Mohs surgeon's opinion and I'm not sure how universal it is.
Janner
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- April 16, 2011 at 5:26 pm
Also, now that I think about it, you may wish to discuss a procedure called MOHS. I have heard and discussed with two other people in the past that have had this done of their face for in situ melanoma. My derm does it, but not all can perform this surgery due to the difficulty and skill involved. Physicians that perform Mohs Micrographic Surgery are highly trained in cancer resection, skin pathology and reconstruction. Physicians certified as Mohs surgeons by the American College of Mohs Micrographic Surgery and Cutaneous Oncology have already obtained board certification in either Dermatology or Plastic Surgery and have further certified training by the American College of Mohs Micrographic Surgery and Cutaneous Oncology as Mohs surgeons. Only physicians who have completed a residency in dermatology or plastic surgery are qualified for Mohs Micrographic Surgery training. These individuals have undertaken fellowship level training, for a minimum of a year, at an American College of Mohs Micrographic Surgery and Cutaneous Oncology qualified training centre.
Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate. It has been used in the removal of melanoma-in-situ (cure rate 77% to 98% depending on surgeon) Because the Mohs procedure is micrographically controlled, it provides precise removal of the cancerous tissue, while healthy tissue is spared. Mohs surgery is relatively expensive when compared to other surgical modalities. However, in anatomically important areas (eyelid, nose, lips), tissue sparing and low recurrence rate makes it a procedure of choice by many physicians.
You can read up on it here:
http://en.wikipedia.org/wiki/Mohs_surgery
Michael
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- April 16, 2011 at 4:47 pm
I just want to point out that while Michael is absolutely correct, 5mm margins are the norm, that doesn't mean your scar will only be 1 cm. Basically, they make an elliptical excision in order to close the wound. In general, the length is 3 times the width so the wound will close. Much depends on the anatomy of the area. I have an in situ excision on my leg where the scar is probably 1.5 inches long. However, the plastic surgeon may have a way to minimize the impact. I'd just be looking for a good plastic surgeon who does facial reconstruction to give you the best possible result.
Best wishes,
Janner
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- April 16, 2011 at 4:47 pm
I just want to point out that while Michael is absolutely correct, 5mm margins are the norm, that doesn't mean your scar will only be 1 cm. Basically, they make an elliptical excision in order to close the wound. In general, the length is 3 times the width so the wound will close. Much depends on the anatomy of the area. I have an in situ excision on my leg where the scar is probably 1.5 inches long. However, the plastic surgeon may have a way to minimize the impact. I'd just be looking for a good plastic surgeon who does facial reconstruction to give you the best possible result.
Best wishes,
Janner
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