diagnosis question

Hi Jason, I am also new here, just went through what you are going through about 3 months ago.  Your path reports as you describe them indicate that the shave biopsies did not get the entire lesion, meaning there is additional tumor left in at least one and possibly both primary sites.  This is why they are recommending additional surgery, a wide local incision (WLE) and sentinel lymphnode biopsy (SLB), because without this information they cannot really stage your lesion's actual depth or the cancer's spread if present, which then determines future treatments.  It is imperative that you find a surgeon(s) with experience in the melanoma business to do the WLE and SLB, and that further pathology reports are requested to provide better guidance on treatment.  Dermatologists generally do not do this, as this can be pretty serious surgery under full anesthesia. 

Yes that could be what it means. No matter what, the worst you've got is in situ (stage 0) melanoma which is confined to the epidermis and has no access to blood or lymph channels so there is no possibility of spread. You only need a WLE to remove extra margins of skin around the biopsy site and regular check ups with a dermatologist to watch for any new/changing moles from now on. I don't like general anesthesia as it makes me very sick, so I had the anesthesiologist give me very little anesthesia and I was half awake during my surgery, but it was much more involed since my melanoma was deep and required a lymph node biopsy. I would say you could probably do these WLEs with local and a sedative instead of the whole general deal, but you'll have to talk to the surgeon about that. In any case, this is not something to overly worry about, you caught it very very early, it's as positive as melanoma can get.

We're also new to this process, but my husband just had surgery to remove a metastatic melanoma from his back. They took a fair amount of tissue – 7×4.5 cm, depth of 2.6cm — under deep sedation (propofol).  We were back home within 2 hours of the surgery.

If anyone has melanoma extensive enough to require a surgeon – find a surgical oncologist. 

If anyone has melanoma extensive enough to require a surgeon – find a surgical oncologist. 

The "standard of care" on MIS is 5 mm around the lesion.  Since your lesion apparently extends to the margins obtained from your biopsy, you should have  a 5 mm margin taken beyond that in all directions (including down to muscle fascia). As to your question about whether this is "usual" or not, I don't know specifically how often that happens, but if your original shave biopsy was small, then I could see how that could happen pretty easily.  If more abnormal cells are found in the WLE sample, they may have to take more to get proper margins – you won't know until path comes back from that (yes, more waiting, not fun).   The WLE results in a rather large scar (if they haven't told you how big it will be yet) – which is a little surprising for such a small mole!  My dermatologist at the University center explained that it would be a football-shaped (or ellipse-shaped) section removed, so they can approximate the cut edges of the WLE more easily and reduce tension on it and the suture line.  My scar was about 3.5 inches long for a pretty typical-sized mole (4 mm).   Depending on where your lesion was, you should have a pretty good cosmetic result – mine is two years "old" now and you can barely see it on my leg.  Just enough there to remind me not to take anything for granted and to stay out of the sun!  Good luck – let us know how it goes.

My shave biopsy extended to the margin (pigmented area) of the incision. The General Surgeon I've signed up with for the Wide Local Excision is planning to take 1 cm in all directions & says this is "world wide standard". My invasive malignant mole was/is 1 cm diameter, is at least 1.1 mm deep (shave biopsy didn't get to the bottom of it) so I have interest in this question as well. (I'm new to melanoma & haven't had any surgeries before).