Dr. Mark

Hello Texan,  Just read your post.  I'm a dentist in Oregon and was diagnosed in July of 2011 with DM.  It is a rare sub-type and in some ways has better long term prognosis than metastatic melanoma.  My lesion was deeper than your dad's and had more mitotic activity which makes my prognosis worse than you dad's.  

I had surgery to remove the lesion just above my left ear.  They couldn't go deep enough to get it all and so radiation treatment was next step.  One year later, I felt a funny spot on the margin of the surgical excision and it was found to be positive for DM.  I had two surgeries since and the last biopsy report was that the margins on the peripheral border were clear but they didn't go deep enough to get it all.  Because I had a graft to cover the site after surgery, they couldn't remove all the tissue down to the bone as an underlying vascular bed is needed for the graft to survive.  

My Dermatologist found an ENT surgeon at OHSU in Portland who does a special procedure to get all the cancer and allow for a vascular bed for the survival of the graft.  What this procedure involves is removing all the tissue down to the bone, then removal of the outer layer of the skull to expose the inner bone portion which has a blood supply.  A wound vac device is placed and the site left to develop a proper vascular bed for a later graft to be placed.  The beauty of this procedure is that the wound vac allows time for the biopsy report to come back.  If all the margins are clear, then the graft is scheduled.  If not, more tissue is removed until you get clear margins.  Right now, I'm at the wound vac stage.

Knowing what I know now, I would have gone with this second procedure first.  It eliminates the need for radiation treatment–which is not guaranteed to kill the remaining DM.  I hope this helps.  God bless you, your dad, and family.

Hello Texan,  Just read your post.  I'm a dentist in Oregon and was diagnosed in July of 2011 with DM.  It is a rare sub-type and in some ways has better long term prognosis than metastatic melanoma.  My lesion was deeper than your dad's and had more mitotic activity which makes my prognosis worse than you dad's.  

I had surgery to remove the lesion just above my left ear.  They couldn't go deep enough to get it all and so radiation treatment was next step.  One year later, I felt a funny spot on the margin of the surgical excision and it was found to be positive for DM.  I had two surgeries since and the last biopsy report was that the margins on the peripheral border were clear but they didn't go deep enough to get it all.  Because I had a graft to cover the site after surgery, they couldn't remove all the tissue down to the bone as an underlying vascular bed is needed for the graft to survive.  

My Dermatologist found an ENT surgeon at OHSU in Portland who does a special procedure to get all the cancer and allow for a vascular bed for the survival of the graft.  What this procedure involves is removing all the tissue down to the bone, then removal of the outer layer of the skull to expose the inner bone portion which has a blood supply.  A wound vac device is placed and the site left to develop a proper vascular bed for a later graft to be placed.  The beauty of this procedure is that the wound vac allows time for the biopsy report to come back.  If all the margins are clear, then the graft is scheduled.  If not, more tissue is removed until you get clear margins.  Right now, I'm at the wound vac stage.

Knowing what I know now, I would have gone with this second procedure first.  It eliminates the need for radiation treatment–which is not guaranteed to kill the remaining DM.  I hope this helps.  God bless you, your dad, and family.

Hello Texan,  Just read your post.  I'm a dentist in Oregon and was diagnosed in July of 2011 with DM.  It is a rare sub-type and in some ways has better long term prognosis than metastatic melanoma.  My lesion was deeper than your dad's and had more mitotic activity which makes my prognosis worse than you dad's.  

I had surgery to remove the lesion just above my left ear.  They couldn't go deep enough to get it all and so radiation treatment was next step.  One year later, I felt a funny spot on the margin of the surgical excision and it was found to be positive for DM.  I had two surgeries since and the last biopsy report was that the margins on the peripheral border were clear but they didn't go deep enough to get it all.  Because I had a graft to cover the site after surgery, they couldn't remove all the tissue down to the bone as an underlying vascular bed is needed for the graft to survive.  

My Dermatologist found an ENT surgeon at OHSU in Portland who does a special procedure to get all the cancer and allow for a vascular bed for the survival of the graft.  What this procedure involves is removing all the tissue down to the bone, then removal of the outer layer of the skull to expose the inner bone portion which has a blood supply.  A wound vac device is placed and the site left to develop a proper vascular bed for a later graft to be placed.  The beauty of this procedure is that the wound vac allows time for the biopsy report to come back.  If all the margins are clear, then the graft is scheduled.  If not, more tissue is removed until you get clear margins.  Right now, I'm at the wound vac stage.

Knowing what I know now, I would have gone with this second procedure first.  It eliminates the need for radiation treatment–which is not guaranteed to kill the remaining DM.  I hope this helps.  God bless you, your dad, and family.