In situ melanoma – just diagnosed.
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In situ melanoma – just diagnosed.

› Forums › General Melanoma Community › In situ melanoma – just diagnosed.

  • Post
    • August 29, 2012 at 10:08 pm
    lilahs
    Participant
    I was recently diagnosed with in situ melanoma on my lower leg. The lab results state "The lesion appears to be completely excised, approximating the nearest margin to within 3mm." Initially on the phone, the doctor told me that even though the standards of care are to remove 5mm from the margins, that he doesn't necessarily feel that I need the additional biopsy. He said that he usually abides by the standards of care, but doesn't believe it is necessary for an additional biopsy.

    I was recently diagnosed with in situ melanoma on my lower leg. The lab results state "The lesion appears to be completely excised, approximating the nearest margin to within 3mm." Initially on the phone, the doctor told me that even though the standards of care are to remove 5mm from the margins, that he doesn't necessarily feel that I need the additional biopsy. He said that he usually abides by the standards of care, but doesn't believe it is necessary for an additional biopsy. When I went in for my appoinment to remove the stitches, I asked multiple questions about the additional biopsy. Now he is telling me that he recommends having it done.  I believe he is saying that to cover his bases. I'm wondering if anyone has any opinions/experience with this situation. I'm comfortable not having the additional biopsy since the margins were clear. I've also had a rough recovery. I don't feel like it is a huge concern to get the additional biopsy, but maybe I'm being to relaxed about it???
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  • Replies
      • August 29, 2012 at 11:06 pm
      Janner
      Participant

      They developed the "standards of care" based on evaluation of many lesions.  In years past, the margins were much larger than they are now.  The best cure for melanoma is surgery so while 2mm might not seem like much, you would be at higher risk.  Yes, you can watch the area for any pigment regrowth and have more removed later if something grows back.  But melanoma cells like to travel which is why the extra margins are called for in the first place.  They can't check every cell on a biopsy so they can't "guarantee" anything when they say "APPEARS to be completely excised".  I'm assuming this lesion is Superficial Spreading Melanoma.  If it were Lentigo Maligna, then I would not be comfortable at all with 3mm margins.  (Lentigo Maligna has a high local recurrence rate).  In the end, it is up to you.  As long as you understand the risks and you are comfortable where you are, then that's all that should matter.    And yes, your doctor is probably covering his tracks now, but remember that the standards of care are on his side.  I've been on this site for almost 11 years and the WLE (wide local excision) or 'additional biopsy' as you call it is done almost every time.  Few exceptions.

      Janner

      • August 29, 2012 at 11:06 pm
      Janner
      Participant

      They developed the "standards of care" based on evaluation of many lesions.  In years past, the margins were much larger than they are now.  The best cure for melanoma is surgery so while 2mm might not seem like much, you would be at higher risk.  Yes, you can watch the area for any pigment regrowth and have more removed later if something grows back.  But melanoma cells like to travel which is why the extra margins are called for in the first place.  They can't check every cell on a biopsy so they can't "guarantee" anything when they say "APPEARS to be completely excised".  I'm assuming this lesion is Superficial Spreading Melanoma.  If it were Lentigo Maligna, then I would not be comfortable at all with 3mm margins.  (Lentigo Maligna has a high local recurrence rate).  In the end, it is up to you.  As long as you understand the risks and you are comfortable where you are, then that's all that should matter.    And yes, your doctor is probably covering his tracks now, but remember that the standards of care are on his side.  I've been on this site for almost 11 years and the WLE (wide local excision) or 'additional biopsy' as you call it is done almost every time.  Few exceptions.

      Janner

      • August 29, 2012 at 11:06 pm
      Janner
      Participant

      They developed the "standards of care" based on evaluation of many lesions.  In years past, the margins were much larger than they are now.  The best cure for melanoma is surgery so while 2mm might not seem like much, you would be at higher risk.  Yes, you can watch the area for any pigment regrowth and have more removed later if something grows back.  But melanoma cells like to travel which is why the extra margins are called for in the first place.  They can't check every cell on a biopsy so they can't "guarantee" anything when they say "APPEARS to be completely excised".  I'm assuming this lesion is Superficial Spreading Melanoma.  If it were Lentigo Maligna, then I would not be comfortable at all with 3mm margins.  (Lentigo Maligna has a high local recurrence rate).  In the end, it is up to you.  As long as you understand the risks and you are comfortable where you are, then that's all that should matter.    And yes, your doctor is probably covering his tracks now, but remember that the standards of care are on his side.  I've been on this site for almost 11 years and the WLE (wide local excision) or 'additional biopsy' as you call it is done almost every time.  Few exceptions.

      Janner

        • August 30, 2012 at 9:28 pm
        lilahs
        Participant

        Thank you for your response.  I'm reconsidering the additional biopsy.  I've already one WLE, but was not looking forward to another one. I'm definitely going to research this more before making my decision.

        • August 30, 2012 at 9:28 pm
        lilahs
        Participant

        Thank you for your response.  I'm reconsidering the additional biopsy.  I've already one WLE, but was not looking forward to another one. I'm definitely going to research this more before making my decision.

        • August 30, 2012 at 9:28 pm
        lilahs
        Participant

        Thank you for your response.  I'm reconsidering the additional biopsy.  I've already one WLE, but was not looking forward to another one. I'm definitely going to research this more before making my decision.

      • September 3, 2012 at 12:08 am
      Brooksy
      Participant

      Good Morning, I have just read your post and cannot believe that your doctor

      has said no to the second cut, i had a melanoma on my tummy and im the one

      that found it had changed and got to it realy fast, my doctor took it off and it came

      back melanoma, i then had a second cut deeper ,even though they said it was incredible

      that i had found this change in mole so soon and it was fantastic news its protocol

      to have the second deeper and wider cut.

       

      So i had that and forgot all about he melanoma and went on living life to the fullest

      little did i know it had returned in my groin i am now on a roller coaster  ,not meaning to

      scare you but like the last person says Melanoma is the horrible one to get as it does

      travel and when it does it travels fast ,mine took a year to show up in my groin as a lump like

      a marble ,then grew to the size of a chook egg within weeks,ive had a huge operation and

      now have lymphodema due to that operation ,and ive also had four weeks of radiation to my

      groin and leg area ,im sore still so doctor is looking at running a PET scan next as he cant

      understand why im still so sore inside as all this happened in january .

       

      if it were me i would have demanded the second cut thats for sure ,i wish you all the luck inthe

      world some of us are so lucky that it never returns some get five years i got one .

      But my fight is not over yet im a survivor and its hard to take me out.

        • September 4, 2012 at 12:06 am
        lilahs
        Participant
        Thank you for your response. I’m sorry to hear that your melanoma returned. I am learning from these responses that melanoma shouldn’t be taken lightly. Initially, I was under the impression from my doctor that I really don’t need to be concerned since the margins were clear and it wasn’t invasive. Also, I’m new to this board and the terminology, so I should make it clear that I already had a small biopsy of just the mole, followed by the WLE, but only had 3mm margins. He said if I didn’t have another WLE, that there is a cream (Aldera) that I can use for 6 weeks. I’m really conflicted now. I’m not looking forward to another WLE, especially since I got an infection first time around, but I also don’t want to blow this off. It just seems like there is so much conflicting information.
        • September 4, 2012 at 4:55 am
        Janner
        Participant

        My doc uses Aldera for Lentigo Maligna but not other types of melanoma.  However, as your lesion was confined entirely to the epidermis, Aldera could be an option.  I'm honestly not sure which way I'd go in your situation.  Certainly, a WLE has some assurance with it but has all the risks including infection.  Aldera is a pain but could be a decent alternative.  I'd go with your gut on this one.  In the future, though, I'd just ask your derm to take 'generous' margins so you're not faced with this decision again.

        • September 12, 2012 at 8:07 pm
        lilahs
        Participant

        I've decided to have another WLE to remove the additional margins.  I went for a 2nd opinion and this doctor told me the same thing as the first- basically there is a very low chance of it coming back or spreading, but he still recommends the standards of care.  Both doctors haven't seen in situ melanoma come back, but this still doesn't give me the reassurance that I need.  I don't want to be the small percentage where it does come back or has spread internally.  Hopefully 2nd time around, I don't get an infection and have an easy recovery 🙂

        • September 13, 2012 at 10:12 pm
        mlbjab
        Participant

        Okay, very confused by the responses here.  Melanoma in situ is confined to the epidermis. There are two responses here of people saying melanoma in situ has become metastatic.  I find that hard to beleive.  Did you all / your loved ones get second opinions on your pathology?  Did you obtain and read the report for yourself?  Biopsy type only matters when the lesion is intersected (cut in half).  In situ is confined to epidermis and has NO depth, there it would be removed with shave (unless lateral margins were involved which would be stated in path report).

        For the original poster – I'm sure your margins are fine.  If it were me, I'd go in and get larger margins, but I understand why you are hesitant to.

        • September 13, 2012 at 10:12 pm
        mlbjab
        Participant

        Okay, very confused by the responses here.  Melanoma in situ is confined to the epidermis. There are two responses here of people saying melanoma in situ has become metastatic.  I find that hard to beleive.  Did you all / your loved ones get second opinions on your pathology?  Did you obtain and read the report for yourself?  Biopsy type only matters when the lesion is intersected (cut in half).  In situ is confined to epidermis and has NO depth, there it would be removed with shave (unless lateral margins were involved which would be stated in path report).

        For the original poster – I'm sure your margins are fine.  If it were me, I'd go in and get larger margins, but I understand why you are hesitant to.

        • September 13, 2012 at 10:12 pm
        mlbjab
        Participant

        Okay, very confused by the responses here.  Melanoma in situ is confined to the epidermis. There are two responses here of people saying melanoma in situ has become metastatic.  I find that hard to beleive.  Did you all / your loved ones get second opinions on your pathology?  Did you obtain and read the report for yourself?  Biopsy type only matters when the lesion is intersected (cut in half).  In situ is confined to epidermis and has NO depth, there it would be removed with shave (unless lateral margins were involved which would be stated in path report).

        For the original poster – I'm sure your margins are fine.  If it were me, I'd go in and get larger margins, but I understand why you are hesitant to.

        • September 12, 2012 at 8:07 pm
        lilahs
        Participant

        I've decided to have another WLE to remove the additional margins.  I went for a 2nd opinion and this doctor told me the same thing as the first- basically there is a very low chance of it coming back or spreading, but he still recommends the standards of care.  Both doctors haven't seen in situ melanoma come back, but this still doesn't give me the reassurance that I need.  I don't want to be the small percentage where it does come back or has spread internally.  Hopefully 2nd time around, I don't get an infection and have an easy recovery 🙂

        • September 12, 2012 at 8:07 pm
        lilahs
        Participant

        I've decided to have another WLE to remove the additional margins.  I went for a 2nd opinion and this doctor told me the same thing as the first- basically there is a very low chance of it coming back or spreading, but he still recommends the standards of care.  Both doctors haven't seen in situ melanoma come back, but this still doesn't give me the reassurance that I need.  I don't want to be the small percentage where it does come back or has spread internally.  Hopefully 2nd time around, I don't get an infection and have an easy recovery 🙂

        • September 4, 2012 at 4:55 am
        Janner
        Participant

        My doc uses Aldera for Lentigo Maligna but not other types of melanoma.  However, as your lesion was confined entirely to the epidermis, Aldera could be an option.  I'm honestly not sure which way I'd go in your situation.  Certainly, a WLE has some assurance with it but has all the risks including infection.  Aldera is a pain but could be a decent alternative.  I'd go with your gut on this one.  In the future, though, I'd just ask your derm to take 'generous' margins so you're not faced with this decision again.

        • September 4, 2012 at 4:55 am
        Janner
        Participant

        My doc uses Aldera for Lentigo Maligna but not other types of melanoma.  However, as your lesion was confined entirely to the epidermis, Aldera could be an option.  I'm honestly not sure which way I'd go in your situation.  Certainly, a WLE has some assurance with it but has all the risks including infection.  Aldera is a pain but could be a decent alternative.  I'd go with your gut on this one.  In the future, though, I'd just ask your derm to take 'generous' margins so you're not faced with this decision again.

        • September 4, 2012 at 12:06 am
        lilahs
        Participant
        Thank you for your response. I’m sorry to hear that your melanoma returned. I am learning from these responses that melanoma shouldn’t be taken lightly. Initially, I was under the impression from my doctor that I really don’t need to be concerned since the margins were clear and it wasn’t invasive. Also, I’m new to this board and the terminology, so I should make it clear that I already had a small biopsy of just the mole, followed by the WLE, but only had 3mm margins. He said if I didn’t have another WLE, that there is a cream (Aldera) that I can use for 6 weeks. I’m really conflicted now. I’m not looking forward to another WLE, especially since I got an infection first time around, but I also don’t want to blow this off. It just seems like there is so much conflicting information.
        • September 4, 2012 at 12:06 am
        lilahs
        Participant
        Thank you for your response. I’m sorry to hear that your melanoma returned. I am learning from these responses that melanoma shouldn’t be taken lightly. Initially, I was under the impression from my doctor that I really don’t need to be concerned since the margins were clear and it wasn’t invasive. Also, I’m new to this board and the terminology, so I should make it clear that I already had a small biopsy of just the mole, followed by the WLE, but only had 3mm margins. He said if I didn’t have another WLE, that there is a cream (Aldera) that I can use for 6 weeks. I’m really conflicted now. I’m not looking forward to another WLE, especially since I got an infection first time around, but I also don’t want to blow this off. It just seems like there is so much conflicting information.
      • September 3, 2012 at 12:08 am
      Brooksy
      Participant

      Good Morning, I have just read your post and cannot believe that your doctor

      has said no to the second cut, i had a melanoma on my tummy and im the one

      that found it had changed and got to it realy fast, my doctor took it off and it came

      back melanoma, i then had a second cut deeper ,even though they said it was incredible

      that i had found this change in mole so soon and it was fantastic news its protocol

      to have the second deeper and wider cut.

       

      So i had that and forgot all about he melanoma and went on living life to the fullest

      little did i know it had returned in my groin i am now on a roller coaster  ,not meaning to

      scare you but like the last person says Melanoma is the horrible one to get as it does

      travel and when it does it travels fast ,mine took a year to show up in my groin as a lump like

      a marble ,then grew to the size of a chook egg within weeks,ive had a huge operation and

      now have lymphodema due to that operation ,and ive also had four weeks of radiation to my

      groin and leg area ,im sore still so doctor is looking at running a PET scan next as he cant

      understand why im still so sore inside as all this happened in january .

       

      if it were me i would have demanded the second cut thats for sure ,i wish you all the luck inthe

      world some of us are so lucky that it never returns some get five years i got one .

      But my fight is not over yet im a survivor and its hard to take me out.

      • September 3, 2012 at 12:08 am
      Brooksy
      Participant

      Good Morning, I have just read your post and cannot believe that your doctor

      has said no to the second cut, i had a melanoma on my tummy and im the one

      that found it had changed and got to it realy fast, my doctor took it off and it came

      back melanoma, i then had a second cut deeper ,even though they said it was incredible

      that i had found this change in mole so soon and it was fantastic news its protocol

      to have the second deeper and wider cut.

       

      So i had that and forgot all about he melanoma and went on living life to the fullest

      little did i know it had returned in my groin i am now on a roller coaster  ,not meaning to

      scare you but like the last person says Melanoma is the horrible one to get as it does

      travel and when it does it travels fast ,mine took a year to show up in my groin as a lump like

      a marble ,then grew to the size of a chook egg within weeks,ive had a huge operation and

      now have lymphodema due to that operation ,and ive also had four weeks of radiation to my

      groin and leg area ,im sore still so doctor is looking at running a PET scan next as he cant

      understand why im still so sore inside as all this happened in january .

       

      if it were me i would have demanded the second cut thats for sure ,i wish you all the luck inthe

      world some of us are so lucky that it never returns some get five years i got one .

      But my fight is not over yet im a survivor and its hard to take me out.

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