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Excision margins and depth query – 19 days postop – do I need to go back to theatre

Forums General Melanoma Community Excision margins and depth query – 19 days postop – do I need to go back to theatre

  • Post
    Leigh
    Participant

    Hi all,

    I am just looking for some thoughts about an issue that has just come up today for me.  I was diagnosed with melanoma recently (0.82, Clarkes IV, mitotic rate<1, no ulceration, no regression, brisk lymphocytes) on my lower foot not that far from my toes and had a WLE with skin graft and SLNB which came back clear thank goodness.  I have been sitting still for almost three weeks now which has been very hard on me and my family as I have a two and a half year old and a 3 month old baby.  The graft still hasn't healed all that well.

    Hi all,

    I am just looking for some thoughts about an issue that has just come up today for me.  I was diagnosed with melanoma recently (0.82, Clarkes IV, mitotic rate<1, no ulceration, no regression, brisk lymphocytes) on my lower foot not that far from my toes and had a WLE with skin graft and SLNB which came back clear thank goodness.  I have been sitting still for almost three weeks now which has been very hard on me and my family as I have a two and a half year old and a 3 month old baby.  The graft still hasn't healed all that well.

    Today in a clinic appointment with a resident/registrar (the surgeon is on holiday still) I realised that the circular dent in my foot is actually not around where the mole was, but around half a cm out and up toward my thigh, rather than down toward my toes.  This means that rather than a 1cm margin from the edge of the melanoma it is more like 0.5cm as far as I can tell.  This seems to have come about because of the way the dermatologist had left the scar.  She did take a photo but I am not sure if it will show where it is located on the foot or if it is just of the melanoma itself.  The margins on the tumour were clear with the initial biopsy and there was nothing further in the WLE tissue on microscopy/staining. 

    I can not quite believe this is happening and I have only just realised this.  I am also very concerned that it looks like the depth of the excision only goes down to the fat layer rather than fascia (the district nurses dressing my foot daily also think this).  Obviously this will all need to be discussed with the surgeon when he comes back but I am anxious to try and figure out what to do as I need to get it done asap if I need to go back to theatre.

    Any comments would be really welcomed, I am finding this whole thing unbelievably difficult to digest and what this means for me and my family.

    Thank you.

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      lhaley
      Participant

      Clear margins in the original biopsy and the wle is great news!  Your first concern should be that your not healing well. You definitely need to have an appointment to deal with that.  When they do the wide excision and then pull the wound together it often looks different than we think it will. The pathology report will often give the dimensions of the sample and will even state what the margins were around the healing scar tissue. Do you have the report yet?

      The Dr. might have pulled the skin to one side.  You could ask for another wle but my thoughts are it would take even longer to heal since you are disturbing an area that hasn't healed yet. Go in when the surgeon gets back and talk to him.  He most likely took his margins from the scar that the derm had left.

      For now, focus on recouperating and taking care of that baby!  If your not satisfied with the surgeons response than get a second opinion!  Remember you did have clear margins both times.

      Linda

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      lhaley
      Participant

      Clear margins in the original biopsy and the wle is great news!  Your first concern should be that your not healing well. You definitely need to have an appointment to deal with that.  When they do the wide excision and then pull the wound together it often looks different than we think it will. The pathology report will often give the dimensions of the sample and will even state what the margins were around the healing scar tissue. Do you have the report yet?

      The Dr. might have pulled the skin to one side.  You could ask for another wle but my thoughts are it would take even longer to heal since you are disturbing an area that hasn't healed yet. Go in when the surgeon gets back and talk to him.  He most likely took his margins from the scar that the derm had left.

      For now, focus on recouperating and taking care of that baby!  If your not satisfied with the surgeons response than get a second opinion!  Remember you did have clear margins both times.

      Linda

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      Janner
      Participant

      Being the veteran of several foot surgeries (unrelated to melanoma), I can say that feet are tough.  They take a long time to heal – they are a long way from the heart and don't heal like other blood rich areas.  You are just going to have to give it time and be patient – never easy but necessary.

      As for the location, I don't think that visually, you are going to be able to determine "the margins".   You are more concerned with the pathology report results than anything else.  WLE's have to work with the anatomy available.  You had a shallow melanoma with no residual melanoma in either the biopsy or WLE.  Chances are, the margins are just fine.  If the residual biopsy scar tissue was just on one edge (leading to an uncentered WLE), the pathology should have noted that.  As for going to the fascia, that is typically what is done on other parts of the anatomy.  However, sometimes the anatomy itself requires the surgeon do something different.  Does the WLE report say that the fat layer was not taken?  Or are you just guessing this based on the sample size?  Do you have copies of the reports?  

      The most likely scenario is that everything was done correctly and you are worried about nothing!  Not to say that it is difficult not to worry about melanoma – it's a shock to the system.  However, you do have a shallow lesion.  I had a very similar one removed 9 years ago on my leg with no further incidence.  At this time, I think you just write down your questions for the surgeon – but then concentrate on your family.  Laying low isn't helping you psyche and is giving you too much time to dwell on things that are probably not a problem.  

      As with any biopsy area, you watch the scar tissue for any signs of pigment regrowth.  If you see something unusual, you see your doctor.  Just make a note of your questions for your surgeon and try hard not to worry in the meantime. 

      Best wishes,

      Janner

      Stage IB since 1992, 3 MM primaries

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      Janner
      Participant

      Being the veteran of several foot surgeries (unrelated to melanoma), I can say that feet are tough.  They take a long time to heal – they are a long way from the heart and don't heal like other blood rich areas.  You are just going to have to give it time and be patient – never easy but necessary.

      As for the location, I don't think that visually, you are going to be able to determine "the margins".   You are more concerned with the pathology report results than anything else.  WLE's have to work with the anatomy available.  You had a shallow melanoma with no residual melanoma in either the biopsy or WLE.  Chances are, the margins are just fine.  If the residual biopsy scar tissue was just on one edge (leading to an uncentered WLE), the pathology should have noted that.  As for going to the fascia, that is typically what is done on other parts of the anatomy.  However, sometimes the anatomy itself requires the surgeon do something different.  Does the WLE report say that the fat layer was not taken?  Or are you just guessing this based on the sample size?  Do you have copies of the reports?  

      The most likely scenario is that everything was done correctly and you are worried about nothing!  Not to say that it is difficult not to worry about melanoma – it's a shock to the system.  However, you do have a shallow lesion.  I had a very similar one removed 9 years ago on my leg with no further incidence.  At this time, I think you just write down your questions for the surgeon – but then concentrate on your family.  Laying low isn't helping you psyche and is giving you too much time to dwell on things that are probably not a problem.  

      As with any biopsy area, you watch the scar tissue for any signs of pigment regrowth.  If you see something unusual, you see your doctor.  Just make a note of your questions for your surgeon and try hard not to worry in the meantime. 

      Best wishes,

      Janner

      Stage IB since 1992, 3 MM primaries

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