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Secondary resection?

Forums General Melanoma Community Secondary resection?

  • Post
    dukester909
    Participant
      Hi again, I posted once before ( https://melanoma.org/legacy/find-support/patient-community/mpip-melanoma-patients-information-page/dazed-confused-mostly-scared ) but basically a 2.2mm deep mel in my belly button. I had WLE surgery to remove umbilicus and SLNB showed negative as did a follow up full body PET scan.

      For those who remember, I was asking earlier about a possible clinical trial option for stage 2 and as it turned out when we went to find out about it the trial had closed earlier in the month, so that was never an option anyway. This was the trial if anyone was interested: https://clinicaltrials.gov/ct2/show/NCT03553836?cond=Melanoma%2C+Stage+II&draw=2&rank=4

      At the meeting with the new oncologist about the possible clinical trial, I brought up the question of whether my original WLE surgery margins were sufficient based on this page:
      https://www.aimatmelanoma.org/how-melanoma-is-treated/surgery/
      which has this chart:
      Thickness (Breslow Depth) of Melanoma Determines the Size of the Margin

      Tumor Thickness Surgical Margin

      In Situ 0.5-0.1 cm
      Less than or equal to 1 mm 1.0 cm
      Greater than 1.0mm to 2.0 mm 1.0-2.0 cm
      Greater than 2.0 to 4.0 mm 2.0 cm

      Mine was 2.2mm, and no mitosis btw. However in reading the path report from my surgery it says “Surgical margins are free by at least 1.0 cm”, which sounds to me like not wide enough?. I asked my surgeon about this and the reply I got was : “additional surgery for a wider margin was likely going to require a much more extensive surgery that would not be worth the benefit since margins were already at least 1 cm. The NCCN guidelines are written with an asterisk that they may be modified to accommodate individual anatomic or functional considerations”.

      So the new oncologist I met with about the clinical trial asked his surgical oncologist about this and he said I could just watch the area for local recurrence (I am going every 3 months to oncologist), or to consider a wider resection if this is going to be hanging over my head worrying about a local recurrence; IOW if I have a local recurrence, will I wish I had had the secondary resection.?

      I am probably going to meet with the surgical oncologist either way to hear what he says about a secondary but I would like to know what the thoughts are here. Sounds like my original surgeon thought a much wider excision there (umbilicus) was going to be quite a big deal. Unfortunately I didn’t know any of this before the original surgery and couldn’t ask these questions then.

      By the way, in looking up clinical trials for stage 2 I came across this trial, which seems to be asking this very question of whether 2cm margin is worthwhile:
      https://clinicaltrials.gov/ct2/show/NCT03860883?cond=Melanoma%2C+Stage+II&draw=2&rank=1

      I thought I could move on to just looking forward to not thinking about all this so much after the trial ended up being closed but now I am back to being dazed and confused again….

      Dukester

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        Mark_DC
        Participant
          Dear dukester

          I dont think there is an easy answer. I was stage IIb lower left leg resected 6 years ago (I lose count), was told I had great margins (SLNB was fine), I could see an oncologist if i really wanted to but no need essentially it was all done. 18 months later a recurrence in same area – so a much bigger WLE with skin graft – Stage III, clear margins. Six months later recurrence. So then put onto immunotherapy, it seems to have worked but it took a long time and only after adding TVEC. A really slow responder.

          My second WLE was much worse than my first, i cant remember how long i was off work – four weeks or longer. Crutches and i have minimal arm strength. Long surgery recovery time – had to rebandage every night and morning. So if you go for a re-excision, make sure to get an assessent of how much more difficult is the surgeery. Also am not sure they will give you, because what are you excising? Insurance company may not allow and surgieon may not have a clear target to aim at.

          On the positive side, you are going to be more observant than I was. I assumed I was done and it would not recur. I should have found this board then. Although you may be too worried, at least this means you will be looking actively for recurrence and should catch it pretty quickly. It took me some time to realise what was going on so I lost more time. With your close monitoring, you wont make the same mistake.

          Good luck with your discussions but I dont you think you need to do it again, just watch closely. But check w your oncologists (and make sure s/he is a melanoma specialist!!!! This is essential!)
          Mark

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