The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Content within the patient forum is user-generated and has not been reviewed by medical professionals. Other sections of the Melanoma Research Foundation website include information that has been reviewed by medical professionals as appropriate. All medical decisions should be made in consultation with your doctor or other qualified medical professional.

In situ melanoma – margins not clear after excision – is it recurrence, or did they just miss some?

Forums General Melanoma Community In situ melanoma – margins not clear after excision – is it recurrence, or did they just miss some?

  • Post
    JulietJ
    Participant

      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

    Viewing 11 reply threads
    • Replies
        JerryfromFauq
        Participant

          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.

          JerryfromFauq
          Participant

            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.

            JerryfromFauq
            Participant

              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.

              LibbyinVA
              Participant
                I agree with Jerry that Janner will give you the best info. In situ is good. Wishing you and you dad all the best. Keep us posted as we do care!

                Libby

                LibbyinVA
                Participant
                  I agree with Jerry that Janner will give you the best info. In situ is good. Wishing you and you dad all the best. Keep us posted as we do care!

                  Libby

                  LibbyinVA
                  Participant
                    I agree with Jerry that Janner will give you the best info. In situ is good. Wishing you and you dad all the best. Keep us posted as we do care!

                    Libby

                    JC
                    Participant

                      in situ isn't "full" melanoma?  then what is it?

                      JC
                      Participant

                        in situ isn't "full" melanoma?  then what is it?

                        JC
                        Participant

                          in situ isn't "full" melanoma?  then what is it?

                          Janner
                          Participant

                            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

                            Janner
                            Participant

                              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

                              Janner
                              Participant

                                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

                                JerryfromFauq
                                Participant

                                  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.

                                  JerryfromFauq
                                  Participant

                                    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.

                                    JerryfromFauq
                                    Participant

                                      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.

                                      LibbyinVA
                                      Participant
                                        Oh, no we can’t…you are the best, Janner!

                                        Libby

                                        LibbyinVA
                                        Participant
                                          Oh, no we can’t…you are the best, Janner!

                                          Libby

                                          LibbyinVA
                                          Participant
                                            Oh, no we can’t…you are the best, Janner!

                                            Libby

                                            DonW
                                            Participant

                                              Hey Jerry — How about an update on you? What have you been up to? You seem to be quiet lately.

                                              DonW
                                              Participant

                                                Hey Jerry — How about an update on you? What have you been up to? You seem to be quiet lately.

                                                DonW
                                                Participant

                                                  Hey Jerry — How about an update on you? What have you been up to? You seem to be quiet lately.

                                                  JulietJ
                                                  Participant

                                                    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

                                                    JulietJ
                                                    Participant

                                                      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

                                                      JulietJ
                                                      Participant

                                                        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

                                                        Janner
                                                        Participant

                                                          Definitely get a copy of the pathology report, but in situ has NO depth and NO mitosis by definition.  So those are things you wouldn't expect to see on an in situ report, only a report with invasive melanoma.

                                                          Janner
                                                          Participant

                                                            Definitely get a copy of the pathology report, but in situ has NO depth and NO mitosis by definition.  So those are things you wouldn't expect to see on an in situ report, only a report with invasive melanoma.

                                                            Janner
                                                            Participant

                                                              Definitely get a copy of the pathology report, but in situ has NO depth and NO mitosis by definition.  So those are things you wouldn't expect to see on an in situ report, only a report with invasive melanoma.

                                                          Viewing 11 reply threads
                                                          • You must be logged in to reply to this topic.
                                                          About the MRF Patient Forum

                                                          The MRF Patient Forum is the oldest and largest online community of people affected by melanoma. It is designed to provide peer support and information to caregivers, patients, family and friends. There is no better place to discuss different parts of your journey with this cancer and find the friends and support resources to make that journey more bearable.

                                                          The information on the forum is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.

                                                          Popular Topics