› Forums › General Melanoma Community › In situ melanoma – margins not clear after excision – is it recurrence, or did they just miss some?
- This topic has 27 replies, 6 voices, and was last updated 12 years, 8 months ago by
Janner.
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- June 7, 2013 at 11:30 pm
Hi all,
This is my first time posting here. I've read many of the posts and appreciate all the good information and wisdom.
I'm posting on behalf of my Dad. He had a melanoma excised from his face in May by a plastic surgeon after his dermatologist took a biopsy and it came back positive. I did not see a pathology report, but the doctor told him it was in situ.
Hi all,
This is my first time posting here. I've read many of the posts and appreciate all the good information and wisdom.
I'm posting on behalf of my Dad. He had a melanoma excised from his face in May by a plastic surgeon after his dermatologist took a biopsy and it came back positive. I did not see a pathology report, but the doctor told him it was in situ.
He got a call today that his lab work came back without clear margins, and they called him in for an appointment. He came home with another bandage on the OTHER side of his face – they had seen another suspicious mole and done a biopsy. And they've scheduled him for another excision in early July to get the rest of the cells that they didn't get the first time around. If the new biopsy turns out to be anything, they'll take care of that one in July too.
He's worried about the news, and I try to reassure him that they just didn't have a proper reading the first time – it's an inexact science, right? – and that they just missed some cells. But I'm worried that it's a recurrence at the same site – can that happen so soon after the original treatment? (Just a month.) Or are we safe assuming that they just didn't get it all the first time?
Thank you all for any insight you might have. I wish you all the best with your and your loved ones' treatment.
Julie
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- June 7, 2013 at 11:44 pm
I'm sure Janner will post the best response, but I will note that on the face they usually try to take a minimum of tissue until they know if it is really melanoma. It is quite likely that this is why they want to do a wider excission now. Glad that they saaid In-situ versus full melanoma.
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- June 7, 2013 at 11:44 pm
I'm sure Janner will post the best response, but I will note that on the face they usually try to take a minimum of tissue until they know if it is really melanoma. It is quite likely that this is why they want to do a wider excission now. Glad that they saaid In-situ versus full melanoma.
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- June 7, 2013 at 11:44 pm
I'm sure Janner will post the best response, but I will note that on the face they usually try to take a minimum of tissue until they know if it is really melanoma. It is quite likely that this is why they want to do a wider excission now. Glad that they saaid In-situ versus full melanoma.
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- June 8, 2013 at 2:16 am
Geez, guys, you all can answer this as well as I can! 🙂
I would wonder if the lesion is "Lentigo Maligna". This type of lesion is often found on sun exposed areas – especially the face. It typically is found in the "in situ" stage but can eventually invade deeper if left alone. Lentigo Maligna has the highest percentage of local recurrence rates. It's just hard to get all the cells. I know my doc uses a couple of methods. One is using a topical cream (Aldara) for several weeks and then doing another excision. The topical chemo reduces the size of the lesion. A Mohs surgeon can also try Mohs surgery on this type of lesion – that's where they do staged excisions and analyze the tissue before they close the wound. If they need larger margins, they go back. Some do this over the course of a day, others may do it one day and keep coming back daily.
If the lesion were superficial spreading, most of the stuff above applies except my doctor would not use the topical cream and depending on the cosmetic location, he may not do Mohs.
A recurrence can happen within a short amount of time if not all cells are removed. As someone else mentioned, they may be a bit more conservative on the face so your father doesn't have a huge defect. It's a balancing act between trying to take enough tissue to remove all cells and being aware cosmetically and functionally of the defect left behind..
Best wishes,
Janner
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- June 8, 2013 at 2:16 am
Geez, guys, you all can answer this as well as I can! 🙂
I would wonder if the lesion is "Lentigo Maligna". This type of lesion is often found on sun exposed areas – especially the face. It typically is found in the "in situ" stage but can eventually invade deeper if left alone. Lentigo Maligna has the highest percentage of local recurrence rates. It's just hard to get all the cells. I know my doc uses a couple of methods. One is using a topical cream (Aldara) for several weeks and then doing another excision. The topical chemo reduces the size of the lesion. A Mohs surgeon can also try Mohs surgery on this type of lesion – that's where they do staged excisions and analyze the tissue before they close the wound. If they need larger margins, they go back. Some do this over the course of a day, others may do it one day and keep coming back daily.
If the lesion were superficial spreading, most of the stuff above applies except my doctor would not use the topical cream and depending on the cosmetic location, he may not do Mohs.
A recurrence can happen within a short amount of time if not all cells are removed. As someone else mentioned, they may be a bit more conservative on the face so your father doesn't have a huge defect. It's a balancing act between trying to take enough tissue to remove all cells and being aware cosmetically and functionally of the defect left behind..
Best wishes,
Janner
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- June 8, 2013 at 2:16 am
Geez, guys, you all can answer this as well as I can! 🙂
I would wonder if the lesion is "Lentigo Maligna". This type of lesion is often found on sun exposed areas – especially the face. It typically is found in the "in situ" stage but can eventually invade deeper if left alone. Lentigo Maligna has the highest percentage of local recurrence rates. It's just hard to get all the cells. I know my doc uses a couple of methods. One is using a topical cream (Aldara) for several weeks and then doing another excision. The topical chemo reduces the size of the lesion. A Mohs surgeon can also try Mohs surgery on this type of lesion – that's where they do staged excisions and analyze the tissue before they close the wound. If they need larger margins, they go back. Some do this over the course of a day, others may do it one day and keep coming back daily.
If the lesion were superficial spreading, most of the stuff above applies except my doctor would not use the topical cream and depending on the cosmetic location, he may not do Mohs.
A recurrence can happen within a short amount of time if not all cells are removed. As someone else mentioned, they may be a bit more conservative on the face so your father doesn't have a huge defect. It's a balancing act between trying to take enough tissue to remove all cells and being aware cosmetically and functionally of the defect left behind..
Best wishes,
Janner
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- June 8, 2013 at 12:03 am
Do a search on here for in-situ and Janner and you wil learn loads about in-situ and that if this is a correct diagnosis there is litle likelehood of advancement to Melanoma.
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- June 8, 2013 at 12:03 am
Do a search on here for in-situ and Janner and you wil learn loads about in-situ and that if this is a correct diagnosis there is litle likelehood of advancement to Melanoma.
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- June 8, 2013 at 12:03 am
Do a search on here for in-situ and Janner and you wil learn loads about in-situ and that if this is a correct diagnosis there is litle likelehood of advancement to Melanoma.
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- June 9, 2013 at 12:49 pm
Thank you all so much, Jerry, Libby, Don, Anonymous and Janner. I greatly appreciate your responses, and I'll talk with my Dad about what I've learned on this site.
It sounds like it might indeed be the Maligna Lentigo Melanoma variety – it was not a very large lesion, but it was probably more like a sunspot in appearance than a typical mole, so the description fits, and it sound like that might help explain why they did not get all of the cells the first time. He was feeling pretty down about that and seemed to think that his "cancer is spreading."
I'll talk with Dad about the Maligna Lentigo, so he can ask his doctor. It sounds as though that if it spreads outward on the skin, it's still in situ, and they can keep after it. We just don't want it growing downwards. And we'll keep hoping that the biopsy taken from the other side of his face on Friday is not cancerous. I would also like to get a copy of the pathology report so I can see how it measured in depth, mitosis and the other measures.
Kind regards to all of you – I hope you are doing well.
Julie
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- June 9, 2013 at 12:49 pm
Thank you all so much, Jerry, Libby, Don, Anonymous and Janner. I greatly appreciate your responses, and I'll talk with my Dad about what I've learned on this site.
It sounds like it might indeed be the Maligna Lentigo Melanoma variety – it was not a very large lesion, but it was probably more like a sunspot in appearance than a typical mole, so the description fits, and it sound like that might help explain why they did not get all of the cells the first time. He was feeling pretty down about that and seemed to think that his "cancer is spreading."
I'll talk with Dad about the Maligna Lentigo, so he can ask his doctor. It sounds as though that if it spreads outward on the skin, it's still in situ, and they can keep after it. We just don't want it growing downwards. And we'll keep hoping that the biopsy taken from the other side of his face on Friday is not cancerous. I would also like to get a copy of the pathology report so I can see how it measured in depth, mitosis and the other measures.
Kind regards to all of you – I hope you are doing well.
Julie
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- June 9, 2013 at 12:49 pm
Thank you all so much, Jerry, Libby, Don, Anonymous and Janner. I greatly appreciate your responses, and I'll talk with my Dad about what I've learned on this site.
It sounds like it might indeed be the Maligna Lentigo Melanoma variety – it was not a very large lesion, but it was probably more like a sunspot in appearance than a typical mole, so the description fits, and it sound like that might help explain why they did not get all of the cells the first time. He was feeling pretty down about that and seemed to think that his "cancer is spreading."
I'll talk with Dad about the Maligna Lentigo, so he can ask his doctor. It sounds as though that if it spreads outward on the skin, it's still in situ, and they can keep after it. We just don't want it growing downwards. And we'll keep hoping that the biopsy taken from the other side of his face on Friday is not cancerous. I would also like to get a copy of the pathology report so I can see how it measured in depth, mitosis and the other measures.
Kind regards to all of you – I hope you are doing well.
Julie
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Tagged: cutaneous melanoma
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