Why don’t they do MOHS surgery initially??

Frozen section technique is not the best technique for determining melanoma.  Melanocytes don't show up well under frozen sections.  Slides done in paraffin and specific stains for melanocytes are a much more accurate technique.  This is why Mohs is not typically done for melanoma.  It was designed for Basal Cell and Squamous Cell carcinoma both of which show up well with frozen sections.  However, my cutaneous oncologist (Mohs surgeon) says he will use it for Lentigo Maligna because that particular type of melanoma has a high local recurrence rate.  That type is probably not what your daughter would have if hers was melanoma- that's typically sun spots gone bad.

I saw the picture Bonnie posted.  I would seek out a ocular reconstructive plastic surgeon if possible or a plastic surgeon well versed with eyes.  I would have the entire lesion excised in one excisional biopsy – not Mohs.  I would only take the lesion, not extra margins until you know for sure what this is.  No need for the biopsy to be more disfiguring than necessary.  If for some reason this were melanoma and she had to have more removed, then you could discuss Mohs or which technique would work best for her specific lesion after you know depth, etc.  Melanoma is quite rare in children so for me, the normal biopsy technique removing the entire lesion in one "clump" still seems the best technique.

Best wishes,

Janner, your neighbor to the north in Utah

Frozen section technique is not the best technique for determining melanoma.  Melanocytes don't show up well under frozen sections.  Slides done in paraffin and specific stains for melanocytes are a much more accurate technique.  This is why Mohs is not typically done for melanoma.  It was designed for Basal Cell and Squamous Cell carcinoma both of which show up well with frozen sections.  However, my cutaneous oncologist (Mohs surgeon) says he will use it for Lentigo Maligna because that particular type of melanoma has a high local recurrence rate.  That type is probably not what your daughter would have if hers was melanoma- that's typically sun spots gone bad.

I saw the picture Bonnie posted.  I would seek out a ocular reconstructive plastic surgeon if possible or a plastic surgeon well versed with eyes.  I would have the entire lesion excised in one excisional biopsy – not Mohs.  I would only take the lesion, not extra margins until you know for sure what this is.  No need for the biopsy to be more disfiguring than necessary.  If for some reason this were melanoma and she had to have more removed, then you could discuss Mohs or which technique would work best for her specific lesion after you know depth, etc.  Melanoma is quite rare in children so for me, the normal biopsy technique removing the entire lesion in one "clump" still seems the best technique.

Best wishes,

Janner, your neighbor to the north in Utah

Although freezing is performed for many skin "thingys", it is a no-no for any lesion suspected to be melanoma. On the off chance it is melanoma, cell damage can occur making it difficult to determine it is indeed melanoma, as well as the possibility of the tumor being transected.

You have it right, the suspected mole is excised and sent off for biopsy to verify what it is before anything else is done. No sense in doing anything else until verifying what the lesion is first.

MOHS is mostly done for basal cell and squamous cell, but I am aware that it has also been done on occasion for insitu melanoma (which has no depth) and very thin melanomas in cosmetically sensitive areas. From my understanding the lesion has to be very thin, and it is up the doctors discretion as well.

As an example:

From: Dermatology Associates of Kingsport

Mohs Micrographic Surgery

2300 W Stone Drive ● Kingsport TN 37660

Telephone 423-246-4961 ● 1-800-445-7274 (VA Toll Free)

Fax 423-245-1200

Using the Mohs Technique for Thin Melanomas

Mohs surgery is usually done to treat non-melanoma skin cancers

(basal cell and squamous cell cancers), but we have modified the

procedure to treat thin melanomas in order to allow for better tracing

of the melanoma roots.

Usually the Mohs technique involves checking the tissue edges in

our office while you wait (all in the same day). For technical reasons,

melanomas must be sent to an outside lab for special stains and

interpretation and therefore it takes about two days to get the report.

Fortunately, we can prepare the tissue in our lab prior to sending it

out so that we are able to map the roots with the Mohs technique

which allows for evaluation of 100% of the margin. This technique is

only done for thin melanomas.

Thus, it needs to be determined what the lesion is before a determination can be made as to what needs to be done next.

So, when you get the biopsy results, you may wish to discuss with the doctor if it can be done in your daughters specific case.

Still betting this is something benign.

Keep the board posted.

Michael

Although freezing is performed for many skin "thingys", it is a no-no for any lesion suspected to be melanoma. On the off chance it is melanoma, cell damage can occur making it difficult to determine it is indeed melanoma, as well as the possibility of the tumor being transected.

You have it right, the suspected mole is excised and sent off for biopsy to verify what it is before anything else is done. No sense in doing anything else until verifying what the lesion is first.

MOHS is mostly done for basal cell and squamous cell, but I am aware that it has also been done on occasion for insitu melanoma (which has no depth) and very thin melanomas in cosmetically sensitive areas. From my understanding the lesion has to be very thin, and it is up the doctors discretion as well.

As an example:

From: Dermatology Associates of Kingsport

Mohs Micrographic Surgery

2300 W Stone Drive ● Kingsport TN 37660

Telephone 423-246-4961 ● 1-800-445-7274 (VA Toll Free)

Fax 423-245-1200

Using the Mohs Technique for Thin Melanomas

Mohs surgery is usually done to treat non-melanoma skin cancers

(basal cell and squamous cell cancers), but we have modified the

procedure to treat thin melanomas in order to allow for better tracing

of the melanoma roots.

Usually the Mohs technique involves checking the tissue edges in

our office while you wait (all in the same day). For technical reasons,

melanomas must be sent to an outside lab for special stains and

interpretation and therefore it takes about two days to get the report.

Fortunately, we can prepare the tissue in our lab prior to sending it

out so that we are able to map the roots with the Mohs technique

which allows for evaluation of 100% of the margin. This technique is

only done for thin melanomas.

Thus, it needs to be determined what the lesion is before a determination can be made as to what needs to be done next.

So, when you get the biopsy results, you may wish to discuss with the doctor if it can be done in your daughters specific case.

Still betting this is something benign.

Keep the board posted.

Michael