Want to Make the Right Choices….But What Are They? Pre-Cancerous Help Please!

My melanoma was on my calf, so my margins were much much larger than the 5mm you're looking at and my calf healed up fine and I have no issues. I have not heard anyone on here mention issues with their WLE, I believe the problems you have read about are very very rare for something so minor. 5mm is tiny and will heal quick and won't cause issues with your usual activity. No reason to leave cells that could maybe turn into something serious.. why risk it?

Standard protocol for a severely atypical lesion are 5mm margins.  This is typically removing all tissue down to the muscle fascia.  There is a fine line between severely atypical lesions and melanoma in situ.  That's why they are typically removed with the same margins.  If you had clean margins, you could risk this and not have the re-excision.  Since your margins were not clean, it's a fairly decent risk leaving cells behind.

  My first melanoma had larger margins and was not on the calf, but right on the shin bone where skin was very tight.  At this time, I played a lot of competitive tennis.  I wrapped the calf well and was playing tennis before the stitches were removed although I did try to take it a little easy.  I've had about 10 WLEs in various areas over the years (one on my calf also) and I've never had any issues being active.  In fact, I've been on this site for over 15 years and honestly have not heard much in the way of problems with WLEs that cause any longterm issues.  Short term – mostly just worrying about stitches being pulled.  Nerve damage?  Yes, some people experience numbness on the skin with large wide excisions, but you aren't having a large re-excision.  And even those do not prevent doing anything active.  Certainly make shaving weird when you cannot feel the skin.  (Many knee surgeries have given me this situation – skin numb but no functional problems).  I honestly think you might be overestimating what typically happens on a WLE.  And remember, this is only 5mm margins – a minimum.  Most people with melanoma have much larger margins.

You can consider Mohs – the only real problem with Mohs and melanocytes are that melanocytes don't show up well using frozen section techniques.  That is how tissue is analyzed for Mohs.  Melanocytes show up better when processed in parafiin and stained.  Mohs is not generally used for melanoma for this reason.  But if you want conservative larger margins, that is definitely a possibility.

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My melanoma in situ was on my left lateral calf.  My WLE was performed by a dermatologist at a major medical center/melanoma center of excellence. I had the recommended excision of 5 mm in each direction down to muscle fascia and have had zero problems with function or loss of sensation on the skin level.  There is a light faded scar now, after 2 years.  I am a very active person – alpine skiing, coaching and racing, jogging, and I have to keep up with my two young boys!  I would look for a surgeon or dermatologist with a ton of experience in removing skin lesions like yours.  You can ask them about complications, but I think you will find that this operation is fairly bread and butter stuff to them unless a flap or skiin graft is necessary. Also, follow recovery recommendations – you will probably find the dialed-down activity for a bit to be the most frustrating part!

I am in the same boat as yourself having had 2 insitus and then a series of WLEs and more biopsies that came back as dysplastic nevi some of which have required larger re exicision. I'm loosing count but think I am up to 8 cuttings for one reason or another since January.  I am an avid cyclist spending many hours on my bike each weekend and also work out with weights at the gym  for about 5 hours a week. My surgeon insists after each procedure that I do not sweat for two weeks, no gym, no cycling allowed. This I find quite a hardship. I try to get multiple procedures done at once so if I have to be idle it isn't for successive two week periods. It has been tough, lots of restarts for training and slow progress at getting up to top shape this season.    

I see the intrusion into my fitness routine as part and pacel of the fight against MM, it can't be avoided, it is what it is. It doesn't make any rational sense to risk reoccurance by avoiding the surgery so that you can enhance your health through uninterrupted excercise. So, I look at it from the perspective that for me, going through these minor surgeries and having to avoid exercise is all part of my being healthy routine.

If your primary motivator to exercise comes from managing anxiety you could investigate alternative practises for managing anxiety so that not exercising does not trigger anxiety for you.