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Moh’s Surgery vs WLE
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Moh’s Surgery vs WLE

› Forums › General Melanoma Community › Moh’s Surgery vs WLE

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    • October 19, 2018 at 4:09 pm
    msnow
    Participant

      Any thoughts on using Moh's vs WLE for clearer margins?

      Already had a excision for removing a legion which turned out to be superficial spreading stage 1a

      breslow depth of .07 with /mitotic 1mm with no ulcertion

      Excision showed clear margins of 4mm, my plastic surgeon wants to take total 10mm in a few weeks to be double sure.  Had a second opinion and Moh's surgery was mentioned.  I am not  worried about a scar which will be considerable after the 10mm excision, just want to choose the best procedure to make sure all is clear for best prognosis.  Thanks for any info!  

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        • October 19, 2018 at 4:42 pm
        doragsda
        Participant

          Mohs is a skin conserving surgery usually used on the face and scalp.   If the lesion was there then Mohs would probably be appropriate given the details of your report.   Otherwise, WLE is the standard and the way you should probably go.

          • October 19, 2018 at 5:18 pm
          Janner
          Participant

            WLE is recommended.  Mohs uses "frozen section" techniques and melanocytes don't show up very well.  Staining and processing in paraffin are the best way to view melanocytes.  Mohs works great for the other cell types for skin cancer.  Some surgeons use "slow Mohs" where they take a sample, stain it and process it in paraffin (same as WLE), then you have to come back usually the next day for the next go around.  If you don't care about the scar, then the WLE is really the standard.

            • October 20, 2018 at 2:50 am
            msnow
            Participant

              Thanks for the great info.  Thinking ahead to my appoint. with the melanoma oncologist should I ask for chest x ray as baseline?  Been researchIng and seems Breslow depth is mostly used to determine if pet scans, mri’s etc are needed at stage 1a.  Is depth of .07mm enough to insist on X-ray even if insurance will not cover costs.  Thanks again for all the support.  

                • October 20, 2018 at 4:10 am
                Janner
                Participant

                  If you want, you can request a chest x-ray.  It won't hurt.  But honestly, it likely won't be much help.  If, in the unlikely chance, you were ever to progress, most do through their lymph nodes first – not organs.  If you were to have lymph node involvement later, then there is the ability to request other scans.  PET/CT/MRI are not justified for stage 1a and insurance won't cover them.  Staging is the criteria used for approving scans and treatment alike and no scans or additional treatment will be approved for stage 1a.  They most likely would cover a simple chest x-ray as they are cheap and easy.  A chest x-ray isn't typically the standard of care for stage 1 at most institutions but again, you could get a chest x-ray if you had a bad cold to rule out pneumonia.  At this point, the WLE is the only standard of care.  Anything above that is done just to make you feel better.  It can all be overwhelming at first but just talk to your doc and get his take and then go from there.  :smiley

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